Provider Demographics
NPI:1194594499
Name:FORDE, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FORDE
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 1:450 JEFFERSON DR UNIT 106
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9567
Mailing Address - Country:US
Mailing Address - Phone:772-353-9435
Mailing Address - Fax:
Practice Address - Street 1:5100 W COPANS RD STE 300
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7700
Practice Address - Country:US
Practice Address - Phone:954-825-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst