Provider Demographics
NPI:1255736385
Name:FORRESTER, KELLI-LYNN
Entity type:Individual
Prefix:
First Name:KELLI-LYNN
Middle Name:
Last Name:FORRESTER
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 1:2 CLEARVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6503
Mailing Address - Country:US
Mailing Address - Phone:845-705-6786
Mailing Address - Fax:845-897-2950
Practice Address - Street 1:2 CLEARVIEW CIR
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6503
Practice Address - Country:US
Practice Address - Phone:845-705-6786
Practice Address - Fax:845-897-2950
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator