Provider Demographics
NPI:1154617553
Name:LA FORGIA, ANTHONY RICHARD (MA)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:RICHARD
Last Name:LA FORGIA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630A WOODBURY DR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-1000
Mailing Address - Country:US
Mailing Address - Phone:941-451-0899
Mailing Address - Fax:941-613-1451
Practice Address - Street 1:630A WOODBURY DR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-1000
Practice Address - Country:US
Practice Address - Phone:941-451-0899
Practice Address - Fax:941-613-1451
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral