Provider Demographics
NPI:1104057306
Name:FORSYTH, DOROTHY (APRN)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2944
Mailing Address - Country:US
Mailing Address - Phone:860-828-6291
Mailing Address - Fax:
Practice Address - Street 1:55 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1728
Practice Address - Country:US
Practice Address - Phone:860-224-6968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000949363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health