Provider Demographics
NPI:1932687118
Name:FORFA, DENNIS J
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:FORFA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WILLIAM ST UNIT D15
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-7723
Mailing Address - Country:US
Mailing Address - Phone:510-496-2732
Mailing Address - Fax:
Practice Address - Street 1:140 MAYHEW WAY STE 606
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4337
Practice Address - Country:US
Practice Address - Phone:510-496-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LMFT-LIC-55922106H00000X
UT12933807-3902106H00000X
NV4410-R106H00000X
WI1470-124106H00000X
MI4101007234106H00000X
OHF.2200238106H00000X
CA113069106H00000X
WYLMFT-268106H00000X
ID8671106H00000X
COMFT.0002132106H00000X
VT100.0134097106H00000X
PAMF001405106H00000X
106H00000X
IN35002211A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist