Mindy E Forman PSYD PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MINDY E FORMAN PSYD PLLC

Practice address

1020 Milwaukee Ave Ste 126
Deerfield, IL 60015-3561

Phone

(248) 703-4880

NPI assigned

Nov 7, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mindy Erin Forman, PSYDNPI 1851768725

Title

Clinical Psychologisy

Phone

(248) 703-4880

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mindy Forman, PSYD

  • Psychologist
  • Libertyville, IL
  • NPI 1851768725
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744934400000",
    "number": "1225639990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 BRISTOL CT",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600154850",
            "telephone_number": "248-703-4880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 MILWAUKEE AVE STE 126",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600153561",
            "telephone_number": "248-703-4880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDY E FORMAN PSYD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-07",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A",
        "authorized_official_last_name": "FORMAN",
        "authorized_official_first_name": "MINDY",
        "authorized_official_middle_name": "ERIN",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGISY",
        "authorized_official_telephone_number": "248-703-4880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "NONE",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://secure.simplepractice.com/practice_settings/messaging_settings/clients",
            "affiliation": "N",
            "endpointDescription": "https://secure.simplepractice.com/practice_settings/messaging_settings/clients",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1020 Milwaukee Ave Ste 110",
            "city": "Deerfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600153555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Midwest Institute of Neurological Discovery, LLC (Mind, LLC)
• Isabella Mijares, RBT
• Jeffrey S Miller, DN
• Minda G Gerber LCSW PLLC
• Mindful Solutions LLC
• MJ Investments & Development Co (Rxcomplete 360)
• Andrea C Monek-Head, BEHAVIOR TECHNICIAN
• Annette Diane Monk, MS, LAT, ATC
• Sashidaran Manikum Moodley, MD
• Maura Jean Mooney, LCSW, CADC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Deerfield, IL
• Providers in Deerfield, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.