Provider Demographics
NPI:1457335135
Name:FORGAC, GREGORY E (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:FORGAC
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 SUNFOREST CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4475
Mailing Address - Country:US
Mailing Address - Phone:419-474-4471
Mailing Address - Fax:419-475-9312
Practice Address - Street 1:3900 SUNFOREST CT
Practice Address - Street 2:SUITE 200
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4475
Practice Address - Country:US
Practice Address - Phone:419-474-4471
Practice Address - Fax:419-475-9312
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00751OtherPARAMOUNT
OH29844919100OtherBWC
OH0476640Medicaid
OH29844919100OtherBWC