Provider Demographics
NPI:1851973127
Name:FORESTAL, JANNELL LYNN
Entity type:Individual
Prefix:
First Name:JANNELL
Middle Name:LYNN
Last Name:FORESTAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANNELL
Other - Middle Name:LYNN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 COURTHOUSE LN STE 3
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1723
Mailing Address - Country:US
Mailing Address - Phone:978-275-9444
Mailing Address - Fax:978-275-9918
Practice Address - Street 1:2 COURTHOUSE LN STE 3
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1723
Practice Address - Country:US
Practice Address - Phone:978-275-9444
Practice Address - Fax:978-275-9918
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health