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General NPI Number Information
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NPI Number | 1508923137
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Entity Type | Organization
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Legal Business Name | MICHAEL A FORMAN PHD INC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 3545 OLENTANGY RIVER ROAD SUITE 214
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City | COLUMBUS
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State | OH
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Zip | 43214-3907
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Country | US
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Telephone | 614-263-5908
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Fax | 614-263-5941
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Provider Business Mailing Address
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Address Line | 3545 OLENTANGY RIVER RD SUITE 214
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City | COLUMBUS
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State | OH
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Zip | 43214-3907
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Country | US
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Telephone | 614-263-5908
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Fax | 614-263-5941
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL A FORMAN
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Credential | PHD
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Telephone | 614-263-5908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4417
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2928
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License Number State | OH
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