Provider Demographics
NPI:1851060495
Name:BYBROOK BEHAVIORAL HEALTH SERVICES, PA
Entity Type:Organization
Organization Name:BYBROOK BEHAVIORAL HEALTH SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROAN
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:FORGIE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:646-591-4970
Mailing Address - Street 1:3065 DANIELS RD # 1077
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-7002
Mailing Address - Country:US
Mailing Address - Phone:352-661-1677
Mailing Address - Fax:407-278-4062
Practice Address - Street 1:3065 DANIELS RD # 1077
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-7002
Practice Address - Country:US
Practice Address - Phone:352-661-1677
Practice Address - Fax:407-278-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty