Basic Information
| Provider Information | |||||||||
| NPI: | 1144246703 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAFORREST | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6605 WEST CENTRAL AVENUE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436171000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198417701 | ||||||||
| FaxNumber: | 4198411691 | ||||||||
| Practice Location | |||||||||
| Address1: | 6605 WEST CENTRAL AVENUE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436171000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198417701 | ||||||||
| FaxNumber: | 4198411691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 02/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 35054001L | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 000000128125 | 01 | OH | ANTHEM BCBS | OTHER | 671296 | 05 | OH | MEDICAID |