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General NPI Number Information
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NPI Number | 1427721836
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Entity Type | Individual
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Provider Name | MS. ALISA FORMAN
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Gender | Female
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 15 HENDRICKSON CT
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City | MANALAPAN
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State | NJ
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Zip | 07726-7900
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Country | US
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Telephone | 732-456-3399
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Fax | 732-414-1825
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Provider Business Mailing Address
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Address Line | 15 HENDRICKSON CT
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City | MANALAPAN
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State | NJ
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Zip | 07726-7900
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Country | US
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Telephone | 732-456-3399
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Fax | 732-414-1825
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | NJ
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