Provider Demographics
NPI:1427879212
Name:FORKER, REBEKAH
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:FORKER
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 1:212 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:NJ
Mailing Address - Zip Code:08049-1409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:NJ
Practice Address - Zip Code:08049-1409
Practice Address - Country:US
Practice Address - Phone:856-602-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health