Bybrook Behavioral Health Services, PA

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

BYBROOK BEHAVIORAL HEALTH SERVICES, PA

Practice address

3065 Daniels Rd # 1077
Winter Garden, FL 34787-7002

Phone

(352) 661-1677

Fax

(407) 278-4062

NPI assigned

Sep 8, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Roan Emanuel Forgie, PMHNP-BC

Title

President

Phone

(646) 591-4970

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631059200000",
    "number": "1851060495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3065 DANIELS RD # 1077",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347877002",
            "telephone_number": "352-661-1677",
            "fax_number": "407-278-4062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3065 DANIELS RD # 1077",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347877002",
            "telephone_number": "352-661-1677",
            "fax_number": "407-278-4062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BYBROOK BEHAVIORAL HEALTH SERVICES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-08",
        "last_updated": "2021-09-08",
        "certification_date": "2021-08-21",
        "status": "A",
        "authorized_official_last_name": "FORGIE",
        "authorized_official_first_name": "ROAN",
        "authorized_official_middle_name": "EMANUEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "646-591-4970",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Winter Garden, FL
• Providers in Winter Garden, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.