JILLIAN LOUISE FORMAN (NPI# 1073169587) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073169587 |
| Entity Type | Individual |
| Full Name | JILLIAN LOUISE FORMAN |
| Practice Address |
2 South Main St., Suite 3 Andover NY 14806 |
| Mailing Address |
67 W University St Alfred NY 14802-1136 |
| Practice Telephone | 6072818815 |
| Mailing Telephone | 6072818815 |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2019-08-12 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
009608-01 | NY | Behavioral Health & Social Service Providers |
| Street Address |
2 SOUTH MAIN ST., SUITE 3 |
| City | ANDOVER |
| State | NY |
| Zip Code | 14806 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083100549 | Chelsea Burdick | Speech-Language Pathologist | 4252 County Road 12, Andover, NY 14806 | 2018-07-09 |
| 1932508421 | Andover Volunteer Ambulance Corp Inc | Ambulance | 60 S. Main Street, Andover, NY 14806 | 2014-08-20 |
| 1902128382 | Cheri Ann Gavin | Licensed Practical Nurse | 10 Pleasant Ave., Andover, NY 14806 | 2010-02-25 |
| 1740437276 | Jennifer Austin Smith | Speech-Language Pathologist | 3135 Elm Street, Andover, NY 14806 | 2008-08-27 |
| 1619151784 | Judith E Okeefe | Licensed Practical Nurse | 4023 Cty Rd12, Andover, NY 14806 | 2007-12-24 |
| 1982719985 | Daniel L Woolston | Nurse Practitioner | 20 Sout Main St, Andover, NY 14806 | 2006-08-20 |
| 1922017128 | William A Coch | Family Medicine | 20 S Main St., Andover, NY 14806 | 2006-08-05 |
| 1174583066 | Trevor James Bechtel | Dentist | 2 Main Street, Andover, NY 14806 | 2006-03-24 |
| 1770569535 | David Douglas Gardner | Dentist | 2 South Main St, Andover, NY 14806 | 2005-12-22 |
| 1649552464 | James Three Seventeen Medical Pllc | Family Medicine | 20 Main St, Andover, NY 14806 | 2011-09-19 |
| Find all providers in zip 14806 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629600689 | Michelle Rose Strafelda | Counselor | 1875 Station Pkwy Nw, Andover, MN 55304-3319 | 2020-02-07 |
| 1619394749 | Samantha Spagnuolo | Counselor | 12 Essex St, Andover, MA 01810-3728 | 2014-03-26 |
| 1326390584 | Rachel Lyn Kusilek | Counselor | 1875 Station Pkwy Nw, Andover, MN 55304-3319 | 2012-10-11 |
| 1114246139 | Amanda Christine Hohag | Counselor | 1875 Station Pkwy Nw, Andover, MN 55304-3319 | 2010-06-01 |
| 1487774816 | Eileen Casto | Counselor | 28 Elm St, Andover, MA 01810-3633 | 2007-03-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184225385 | Ellen Rubenfeld | Counselor | 186 Gannet Ct, Manhasset, NY 11030-4011 | 2020-11-04 |
| 1902407125 | Kelly Elizabeth Abbe | Counselor | 32 Eastport Dr, Sound Beach, NY 11789-1329 | 2020-11-04 |
| 1285232454 | Alexandra Nastasi | Counselor | 368 Veterans Hwy Ste 3, Commack, NY 11725-4322 | 2020-10-11 |
| 1881291391 | Maria Preston | Counselor | 33 Saint Marks Ave, Rockville Centre, NY 11570-4244 | 2020-10-07 |
| 1124633821 | Patricia M Fischetti | Counselor | 8312 12th Ave, Brooklyn, NY 11228-2936 | 2020-09-10 |
| 1770197113 | Seema Ahmed | Counselor | 8784 172nd St, Jamaica, NY 11432-4650 | 2020-09-02 |
| 1073126926 | Elizabeth Connolly | Counselor | 1 Speaker St, Commack, NY 11725-2012 | 2020-08-28 |
| 1871101949 | Lauren Jukofsky | Counselor | 2749 Brook Ave, Oceanside, NY 11572-2034 | 2020-07-15 |
| 1477176089 | Jennifer Lyn Ashley | Counselor | 4 Shutt St, Dansville, NY 14437-9158 | 2020-05-19 |
| 1710509799 | Laridian Koinonia | Counselor | 8115 5th Ave, Brooklyn, NY 11209-4102 | 2020-05-12 |
| Find all providers with the same taxonomy | ||||
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| 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.