Provider Demographics
NPI:1285796854
Name:FORREST, CARRIE LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LEE
Last Name:FORREST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 PEARL ST # D2
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3061
Mailing Address - Country:US
Mailing Address - Phone:831-333-9304
Mailing Address - Fax:831-333-9304
Practice Address - Street 1:444 PEARL ST # D2
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3061
Practice Address - Country:US
Practice Address - Phone:831-333-9304
Practice Address - Fax:831-333-9304
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL117282Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER