Jillian Louise Forman

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

009608-01 Issued in NY

Practice address

2 South Main St., Suite 3
Andover, NY 14806

Phone

(607) 281-8815

NPI assigned

Aug 12, 2019

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 12, 2019.

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1073169587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 W UNIVERSITY ST",
            "city": "ALFRED",
            "state": "NY",
            "postal_code": "148021136",
            "telephone_number": "607-281-8815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SOUTH MAIN ST., SUITE 3",
            "city": "ANDOVER",
            "state": "NY",
            "postal_code": "14806",
            "telephone_number": "607-281-8815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "JILLIAN",
        "middle_name": "LOUISE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-12",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NY",
            "license": "009608-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trevor James Bechtel, D.M.D.
• Chelsea Burdick, M.S. CCC-SLP
• William A Coch, MD
• Kimberly D Cowburn, LCSW
• Wendy Dailey
• David Douglas Gardner
• James Three Seventeen Medical PLLC
• Jillian L Forman LMHC NCC PLLC
• Susan Roberta Knight
• Alexis K Niedermaier, NP

• All providers in Andover, NY
• Professional Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.