Provider Demographics
NPI:1639671167
Name:FOREST, KELLSEY REBECCA (MSW)
Entity Type:Individual
Prefix:
First Name:KELLSEY
Middle Name:REBECCA
Last Name:FOREST
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 F ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-5053
Mailing Address - Country:US
Mailing Address - Phone:563-889-0375
Mailing Address - Fax:
Practice Address - Street 1:415 NEPONSET AVE STE 3
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-3169
Practice Address - Country:US
Practice Address - Phone:857-217-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health