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NPI Code Detail

MEDICARE: LAURA G FORMAN PHD

MEDICARE: LAURA G FORMAN PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist0810001083VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346322674
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA G FORMAN PHD
Provider Business Mailing Address
First Line : 327 W 21ST ST
Second Line : SUITE 205
City : NORFOLK
State : VA
Zip : 23517-2130
Country : US
Telephone Number : 757-622-9852
Fax Number : 757-622-4033
Provider Business Practice Location Address
First Line : 327 W 21ST ST
Second Line : SUITE 205
City : NORFOLK
State : VA
Zip : 23517-2130
Country : US
Telephone Number : 757-622-9852
Fax Number : 757-622-4033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 07/08/2007

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