Forman, Mindy

Forman, Mindy is an individual health care provider with primary practice located at 1248 American Way , Libertyville IL 60048-3936. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Forman, Mindy can be contacted via phone (224) 433-6744.

Contact Information

Primary practice address
1248 American Way Libertyville IL 60048-3936
Phone: (224) 433-6744
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X
Behavioral Health & Social Service Providers / Psychologist 103T00000X 071.009917 Illinois

Profile Details

NPI number 1851768725
LBN Legal business name Forman, Mindy
Credentials PSYD
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 27th, 2015
Last updated Dec 13th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851768725 NPPES
Illinois MEDICAID 1851768725

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