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Individual
MS. MELISA FORMAN
Active
Individual
MS. MELISA FORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
A.T.R., L.P.C.
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
001617
CT
101YP2500X
Professional Counselor
Primary
007920
PA
221700000X
Art Therapist
08-011
—
Other
Enumeration date
12/22/2009
Last updated
12/05/2014
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