Provider Demographics
NPI:1508088451
Name:FORREST, DEBRA J (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:J
Last Name:FORREST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:J
Other - Last Name:WILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT OFFICE
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2212
Mailing Address - Country:US
Mailing Address - Phone:860-679-7503
Mailing Address - Fax:860-679-1610
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:PSYCHIATRY OFFICE
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-6410
Practice Address - Country:US
Practice Address - Phone:860-679-6700
Practice Address - Fax:860-679-6736
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0448482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1508088451Medicaid
CTD400034968Medicare PIN