Provider Demographics
NPI:1285299248
Name:WALKER, FORREST LAMBDON SR (PHD)
Entity type:Individual
Prefix:DR
First Name:FORREST
Middle Name:LAMBDON
Last Name:WALKER
Suffix:SR
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:PO BOX 6221
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-0221
Mailing Address - Country:US
Mailing Address - Phone:908-361-2606
Mailing Address - Fax:908-561-0616
Practice Address - Street 1:506 SOUTH AVENUE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062
Practice Address - Country:US
Practice Address - Phone:908-758-8988
Practice Address - Fax:908-561-0616
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLWA74791103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0100929566OtherBUSINESS CERTIFICATION NUMBER