MS. KRISTEN MARIE FORMAN LCSW
NPI 1285105403
Social Worker - Clinical in Ridgewood, NJ
NPI Status: Active since December 16, 2018
Contact Information
115 PINE STREET
SUITE 303
RIDGEWOOD, NJ
ZIP 07450
Phone: (201) 564-0597
Fax: (201) 670-1214
- Individual
- Female
- Social Worker
- Clinical
- Opted-Out Medicare
About KRISTEN FORMAN
This page provides the complete NPI Profile along with additional information for Kristen Forman, a provider established in Ridgewood, New Jersey with a medical specialization in Social Worker, focusing in clinical . The healthcare provider is registered in the NPI registry with number 1285105403 assigned on December 2018. The practitioner's primary taxonomy code is 1041C0700X with license number 44SC05624500 (NJ). The provider is registered as an individual and her NPI record was last updated 3 years ago.
- NPI
- 1285105403
- Provider Name
- MS. KRISTEN MARIE FORMAN LCSW
- Other Name
- MS. KRISTEN GREANY LSW
- Other Name Type
- Former Name (1)
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 115 PINE STREET SUITE 303 RIDGEWOOD, NJ 07450
- Location Phone
- (201) 564-0597
- Location Fax
- (201) 670-1214
- Mailing Address
- 115 PINE STREET SUITE 303 RIDGEWOOD, NJ 07450
- Mailing Phone
- (201) 564-0597
- Mailing Fax
- (201) 670-1214
- Is Sole Proprietor?
- No
- Enumeration Date
- 12-16-2018
- Last Update Date
- 07-06-2022
- Code Navigator
A clinical social worker like Kristen Forman is licensed to diagnose and treat mental, behavioral, and emotional disorders. A clinical social worker helps patients develop strategies to change behavior or cope with difficult situations and refer patients to other resources or services, such as support groups or other mental health professionals.
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Kristen Forman opted out of Medicare effective on 10-01-2018 until 10-01-2026. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare and cannot order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Social Worker Clinical
- Taxonomy Code
- 1041C0700X
- Type
- Behavioral Health & Social Service Providers
- License No.
- 44SC05624500
- License State
- NJ
- Taxonomy Description
- A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Medicare Participation & PECOS Enrollment Status
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 10-01-2018
Opt-Out End Date: 10-01-2026
Eligible to Order and Refer? No
Reviews for MS. KRISTEN MARIE FORMAN LCSW
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 2 | 8 | 5 | 1 | 0 | 5 | 4 | 0 | 3 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 2 | 16 | 5 | 2 | 0 | 10 | 4 | 0 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 2 + 1 + 6 + 5 + 2 + 0 + 1 + 0 + 4 + 0 + 24 = 47 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 50 - 47 = 3 | 3 | ||||||||
The NPI number 1285105403 is valid because the calculated check digit 3 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 2 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1679802516 | JASMINE ALONI-COHN L.C.S.W. Individual | Social Worker (Clinical) | 115 PINE STREET RIDGEWOOD, NJ 07450 (201) 652-6843 |
| 1669588968 | MRS. SUSAN JOAN DONNELLY LCSW Individual | Social Worker | 115 PINE STREET RIDGEWOOD, NJ 07450 (201) 447-0364 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1285105403, enumerated in the NPI registry as an "individual" on December 16, 2018
The provider is located at 115 Pine Street Suite 303 Ridgewood, Nj 07450 and the phone number is (201) 564-0597
The provider's speciality is Social Worker with taxonomy code 1041C0700X with a focus in Clinical
No, the provider signed an affidavit on October 01, 2018 to opt-out of the Medicare program. The provider is excluded from the Medicare program until October 01, 2026.
This NPI record was last updated on December 16, 2018. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.