EMILY BRONSON FORMAN (NPI# 1104372879) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104372879 |
| Entity Type | Individual |
| Full Name | EMILY BRONSON FORMAN |
| Practice Address |
230 Main Street Ext Middletown CT 06457-4470 |
| Mailing Address |
230 Main Street Extension P.0. Box 1000 Middletown CT 06457 |
| Practice Telephone | 8603435303 |
| Mailing Telephone | 8603435303 |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2016-08-31 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346512043 | Emily M Forman | Acupuncturist | 220 Forsgate Dr, Jamesburg, NJ 08831-1375 | 2012-01-27 |
| 1205118411 | Emily A. Forman | Dietitian, Registered | 12586 Avenue 408, Orosi, CA 93647-9454 | 2011-09-13 |
| Street Address |
230 MAIN STREET EXT |
| City | MIDDLETOWN |
| State | CT |
| Zip Code | 06457-4470 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518948025 | Gilead Community Services, Inc. | Clinic/Center | 230 Main Street Ext, Middletown, CT 06457-4470 | 2005-11-10 |
| 1912531138 | Sharma Piersall | Social Worker | 230 Main Street Ext, Middletown, CT 06457-4470 | 2020-02-26 |
| 1437703873 | Michael Anthony Black | Counselor | 230 Main Street Ext, Middletown, CT 06457-4470 | 2019-07-24 |
| 1518405059 | Psychiatry Associates of Connecticut | Psychologist | 230 Main Street Ext, Middletown, CT 06457-4470 | 2017-02-04 |
| 1225571508 | Edward Ureta | Counselor | 230 Main Street Ext, Middletown, CT 06457-4470 | 2016-11-18 |
| 1548657265 | Debra J Bailey | Counselor | 230 Main Street Ext, Middletown, CT 06457-4470 | 2015-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699391961 | Meghan Harrington | Behavior Technician | 101 Centerpoint Drive #243, Middletown, CT 06457 | 2020-06-22 |
| 1427619626 | Collaborative Aba Services, LLC | Behavioral Analyst | 515 Centerpoint Drive, Suite 205, Middletown, CT 06457 | 2019-06-27 |
| 1376100339 | Kimberly Tynik | Pharmacist | 451 Fowler Ave, Middletown, CT 06457 | 2019-05-24 |
| 1184101263 | Tabrez Adil | Dentist | 675 Main St., Middletown, CT 06457 | 2018-07-23 |
| 1326535337 | Rehan Khan | Non-emergency Medical Transport (VAN) | 765 Country Club Rd, Middletown, CT 06457 | 2018-04-16 |
| 1366950206 | State of Connecticut | Psychiatric Hospital | 70 O'brien Drive, Middletown, CT 06457 | 2018-01-12 |
| 1902324536 | Cynthia Tine | Physical Therapy Assistant | 628 Congdon Street, Middletown, CT 06457 | 2017-09-04 |
| 1619494390 | Nathan Douglas Roy | Specialist/Technologist | 431 Briarwood Lane, Middletown, CT 06457 | 2017-08-24 |
| 1598286502 | Rachel Hoffman Whelen | Registered Nurse | 420 Saybrook Road, Suite A, Middletown, CT 06457 | 2017-06-29 |
| 1003358326 | Rebecca Rotondo | Social Worker | 230 Main Street Extension, Act Team, Gilead Community Services, Middletown, CT 06457 | 2016-11-17 |
| Find all providers in zip 06457 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225641210 | Channel Malissa Reeder | Counselor | 31 Meadow View Dr, Middletown, NY 10940-3358 | 2020-08-28 |
| 1285244889 | Jenna D Howard | Counselor | 832 Guthrie Cir, Middletown, DE 19709-9977 | 2020-08-07 |
| 1952910150 | Tiyahna Miles | Counselor | 336 Liborio Dr, Middletown, DE 19709-3111 | 2020-07-24 |
| 1427671478 | Shannon M. Pine | Counselor | E Admiralty Drive, 2, Middletown, RI 02842 | 2020-05-26 |
| 1366080624 | Jennifer Calahan | Counselor | 10 Jersey Ct, Middletown, DE 19709-6813 | 2019-12-18 |
| 1679111991 | Better Days Counseling, LLC | Counselor | 360 Main St Apt 2, Middletown, CT 06457-3375 | 2019-12-17 |
| 1508425612 | Shatema Smith | Counselor | 4 Cobb Ln Apt J, Middletown, NY 10940-7049 | 2019-06-12 |
| 1801371729 | Taylor S Smith | Counselor | 1801 Oberlin Rd Ste 30312, Middletown, PA 17057-2998 | 2018-09-26 |
| 1922586288 | Christiana Care Health Services Inc | Counselor | 1080 Bunker Hill Rd, Middletown, DE 19709-9026 | 2018-07-30 |
| 1295227148 | Nicole May | Counselor | 11 Jimal Dr, Middletown, NY 10940-3649 | 2018-06-05 |
| Find all providers in MIDDLETOWN | ||||
| City | MIDDLETOWN |
| Zip Code | 06457 |
Please comment or provide details below to improve the information on EMILY BRONSON FORMAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.