Provider Demographics
NPI:1285458034
Name:FORSYTHE, ANTHONY PRESTON (BT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PRESTON
Last Name:FORSYTHE
Suffix:
Gender:M
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E HAMILTON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0834
Mailing Address - Country:US
Mailing Address - Phone:845-814-2642
Mailing Address - Fax:
Practice Address - Street 1:6228 FILBERT AVE STE 3
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4106
Practice Address - Country:US
Practice Address - Phone:845-814-2642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician