Provider Demographics
NPI:1407300775
Name:FORSLEY, PHOEBE
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:FORSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 JOURNEYS END RD
Mailing Address - Street 2:
Mailing Address - City:FRANCESTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03043-3510
Mailing Address - Country:US
Mailing Address - Phone:617-901-3500
Mailing Address - Fax:
Practice Address - Street 1:526 JOURNEYS END RD
Practice Address - Street 2:
Practice Address - City:FRANCESTOWN
Practice Address - State:NH
Practice Address - Zip Code:03043-3510
Practice Address - Country:US
Practice Address - Phone:617-901-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-19556103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst