Maryelizabeth Forman (NPI# 1750384103, PAC ID# 4284828815) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CLINICAL PSYCHOLOGIST.
| Nation Provider ID (NPI) | 1750384103 |
| PAC ID by PECOS | 4284828815 |
| Professional Enrollment ID | I20101027001573 |
| Full Name | Maryelizabeth Forman |
| Organization Legal Name | OUR LADY OF LAKE ASCENSION, LLC |
| Address |
2647 S St Elizabeth Boulevard Gonzales LA 70737-5019 |
| Phone Number | 2256478511 |
| Gender | F |
| Graduation Year | 2002 |
| Primary Specialty | CLINICAL PSYCHOLOGIST |
| Group Practice PAC ID | 3577452259 |
| Number of Group Practice Members | 67 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 2647 S St Elizabeth Boulevard, Gonzales, LA 70737-5019 | 2256478511 | OUR LADY OF LAKE ASCENSION, LLC |
| Organization Legal Name | OUR LADY OF LAKE ASCENSION, LLC |
| Physicians | 6 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mydhili Kanumilli | Internal Medicine | Our Lady of Lake Ascension, LLC | 2647 S St Elizabeth Boulevard, Gonzales, LA 70737-5019 |
| Paula D Julian | Nurse Practitioner | Our Lady of Lake Ascension, LLC | 1937 S Burnside Ave, Gonzales, LA 70737-4632 |
| Sean N Debarros | Family Practice | Our Lady of Lake Ascension, LLC | 2647 S St Elizabeth Boulevard, Gonzales, LA 70737-5019 |
| Sarah M Wilks | Pediatric Medicine | Our Lady of Lake Ascension, LLC | 2647 S St Elizabeth Boulevard, Gonzales, LA 70737-5019 |
| Lakisha Lee | Pediatric Medicine | Our Lady of Lake Ascension, LLC | 2647 S St Elizabeth Boulevard, Gonzales, LA 70737-5019 |
| Street Address |
2647 S ST ELIZABETH BOULEVARD |
| City | GONZALES |
| State | LA |
| Zip | 70737-5019 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mydhili Kanumilli | Internal Medicine | Our Lady of Lake Ascension, LLC | 2647 S St Elizabeth Boulevard, Gonzales, LA 70737-5019 |
| Sean N Debarros | Family Practice | Our Lady of Lake Ascension, LLC | 2647 S St Elizabeth Boulevard, Gonzales, LA 70737-5019 |
| Sarah M Wilks | Pediatric Medicine | Our Lady of Lake Ascension, LLC | 2647 S St Elizabeth Boulevard, Gonzales, LA 70737-5019 |
| Lakisha Lee | Pediatric Medicine | Our Lady of Lake Ascension, LLC | 2647 S St Elizabeth Boulevard, Gonzales, LA 70737-5019 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Hailey R Entremont | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 1702 N Burnside Ave, Suite A, Gonzales, LA 70737-2141 |
| Sharon D Lobell | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 1702 N Burnside Ave, Suite A, Gonzales, LA 70737-2141 |
| Paul C Aguillard Jr. | Pediatric Medicine | Our Lady of The Lake Physician Group LLC | 1702 N Burnside Ave, Suite A, Gonzales, LA 70737-2141 |
| Annie K Lanclos | Nurse Practitioner | Lake Urgent Care Ascension LLC | 1702 N Burnside Ave, Lake Urgent Care Gonzales, Gonzales, LA 70737-2141 |
| Raymond Dyer | Physical Therapy | Alliance Therapy Services, Inc | 12320 Hwy 44 3f, Gonzales, LA 70737-2202 |
| Veronica D Walker | Qualified Speech Language Pathologist | Alliance Therapy Services, Inc | 12320 Hwy 44 3f, Gonzales, LA 70737-2202 |
| Donna P Aguillard | Occupational Therapy | Alliance Therapy Services, Inc | 12320 Hwy 44 3f, Gonzales, LA 70737-2202 |
| Jeremy C Catoire | Physical Therapy | 12550 Airline Hwy, Suite 102, Gonzales, LA 70737-2258 | |
| Brian S Christopherson | Optometry | 308 N Airline, Brian S Christopherson Od, Gonzales, LA 70737-3009 | |
| Phillip L Smith | Chiropractic | 208 E Cornerview St, Smith Chiropractic Clinic, Gonzales, LA 70737-3150 | |
| Find all physicians in zip 70737 | |||
| City | GONZALES |
| Zip Code | 70737 |
| Specialty | CLINICAL PSYCHOLOGIST |
| City + Specialty | GONZALES + CLINICAL PSYCHOLOGIST |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.