| Doctor Name: | MS. MAUREEN HARRIS FORMAN |
| NPI Number: | 1023395514 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | LCS14661 |
| Business Practice Address: | 490 S Farrell Dr Suite C 208 Palm Springs, CA - 922627992 |
| Business Phone Number: | 7603254088 |
| Business Fax Number: | 7607783781 |
| Mailing Address: | 73875 Krug Ave, PALM DESERT |
| State: | CA |
| Postal Code: | 922609320 |
| Phone Number: | 7608958610 |
| Fax Number: | |
| NPI Enumeration Date: | 11/10/2011 |
| NPI Last Update Date: | 11/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCS14661 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |