Provider Demographics
NPI:1982657532
Name:FOREHAND, REX L (PH D)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:L
Last Name:FOREHAND
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COLCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05405-1764
Mailing Address - Country:US
Mailing Address - Phone:802-656-2661
Mailing Address - Fax:802-656-3485
Practice Address - Street 1:2 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-1764
Practice Address - Country:US
Practice Address - Phone:802-656-2661
Practice Address - Fax:802-656-3485
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000820103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009876Medicaid
VT59550OtherBCBS
VN3220Medicare ID - Type Unspecified