Provider Demographics
NPI:1457776312
Name:FOREST, DENISE (CA LMFT #83489)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:FOREST
Suffix:
Gender:
Credentials:CA LMFT #83489
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SHATTUCK AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-3402
Mailing Address - Country:US
Mailing Address - Phone:415-488-5802
Mailing Address - Fax:
Practice Address - Street 1:1700 SHATTUCK AVE STE 214
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-3402
Practice Address - Country:US
Practice Address - Phone:415-488-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2025-02-26
Deactivation Date:2018-04-09
Deactivation Code:
Reactivation Date:2025-02-13
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X
CA83489106H00000X
CARI-F1208281608101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00OtherACBHCS