Provider Demographics
NPI:1558036723
Name:FORRESTER, THEO (MA)
Entity Type:Individual
Prefix:
First Name:THEO
Middle Name:
Last Name:FORRESTER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:EVANOSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:133 KEEFER DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-3935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1841 UNIVERSAL RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-3955
Practice Address - Country:US
Practice Address - Phone:412-403-8108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health