| Mindy E Forman Psyd Llc | |
|
1020 Milwaukee Ave Ste 110 Deerfield IL 60015-3555 | |
| (248) 703-4880 | |
| Not Available |
| Full Name | Mindy E Forman Psyd Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1020 Milwaukee Ave Ste 110, Deerfield, Illinois |
| Authorized Official Name and Position | Mindy Erin Forman (CLINICAL PSYCHOLOGISY) |
| Authorized Official Contact | 2487034880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindy E Forman Psyd Llc 255 Bristol Ct Deerfield IL 60015-4850 Ph: (248) 703-4880 | Mindy E Forman Psyd Llc 1020 Milwaukee Ave Ste 110 Deerfield IL 60015-3555 Ph: (248) 703-4880 |
| NPI Number | 1225639990 |
|---|---|
| Provider Enumeration Date | 11/07/2020 |
| Last Update Date | 12/07/2020 |
| Certification Date | 12/07/2020 |
| Medicare PECOS PAC ID | 3173934916 |
|---|---|
| Medicare Enrollment ID | O20201130000600 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225639990 | NPI | - | NPPES |
| NONE | Other | NONE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mindy E Forman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851768725 PECOS PAC ID: 5890034763 Enrollment ID: I20190312001003 |
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