Provider Demographics
NPI:1316764616
Name:FORREY, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:FORREY
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 1:246 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1517
Mailing Address - Country:US
Mailing Address - Phone:440-864-8771
Mailing Address - Fax:
Practice Address - Street 1:36711 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4062
Practice Address - Country:US
Practice Address - Phone:216-282-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-24-74836103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst