| Laura G Forman, Psy.d, Fapa, Llc | |
|
129 W Virginia Beach Blvd # 204b Norfolk VA 23510-2030 | |
| (757) 550-1735 | |
| (757) 622-4033 |
| Full Name | Laura G Forman, Psy.d, Fapa, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 129 W Virginia Beach Blvd # 204b, Norfolk, Virginia |
| Authorized Official Name and Position | Laura G Forman (OWNER) |
| Authorized Official Contact | 7575501735 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Laura G Forman, Psy.d, Fapa, Llc 129 W Virginia Beach Blvd # 204b Norfolk VA 23510-2030 Ph: (757) 550-1735 | Laura G Forman, Psy.d, Fapa, Llc 129 W Virginia Beach Blvd # 204b Norfolk VA 23510-2030 Ph: (757) 550-1735 |
| NPI Number | 1376288571 |
|---|---|
| Provider Enumeration Date | 05/02/2022 |
| Last Update Date | 05/03/2022 |
| Certification Date | 05/03/2022 |
| Medicare PECOS PAC ID | 7719364751 |
|---|---|
| Medicare Enrollment ID | O20220513000996 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376288571 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Laura G Forman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346322674 PECOS PAC ID: 6204843642 Enrollment ID: I20060309000681 |
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