Individual
EMILY BRONSON FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
230 MAIN STREET EXT, MIDDLETOWN, CT 06457-4470
(860) 343-5303
Mailing address
230 MAIN STREET EXTENSION P.0. BOX 1000, MIDDLETOWN, CT 06457
(860) 343-5303
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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