Provider Demographics
NPI:1609340413
Name:FOREST, LABRINA JEAN
Entity Type:Individual
Prefix:
First Name:LABRINA
Middle Name:JEAN
Last Name:FOREST
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 1:215 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2927
Mailing Address - Country:US
Mailing Address - Phone:315-703-8700
Mailing Address - Fax:
Practice Address - Street 1:215 WYOMING ST STE 202
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2928
Practice Address - Country:US
Practice Address - Phone:315-703-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker