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Individual
MS. ELISSA FORMAN
Active
Individual
MS. ELISSA FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1031672
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102517
FALLON
MA
01
—
3172516
CIGNA BEHAVIORAL HEALTH
MA
01
—
33214
HEALTH NEW ENGLAND
MA
01
—
468597
TUFTS HEALTH PLAN
MA
01
—
593372000
MAGELLAN BEHAVIORAL HEALT
MA
01
—
P07575
BLUE CROSS BLUE SHIELD
MA
Enumeration date
03/14/2006
Last updated
12/11/2023
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