Active NPI
Heidi Tara Fogarty, LMSW
- Clinical Social Worker
- Port Huron, MI
National Provider Identifier
1083627335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801068838
- Practice address
- 2875 Henry St
Port Huron, MI 48060-2526 - Phone
- (810) 987-9700
- Fax
- (810) 987-9148
- NPI assigned
- Aug 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801068838 | MI | Primary |
Addresses
Primary practice location
2875 Henry St
Port Huron, MI 48060-2526
Mailing address
631 Scott Rd
Kimball, MI 48074-3703
Phone (810) 367-7861
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801068838 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Clair County Community Mental Health Authority | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Marine City, MI
- NPI 1821133265
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083627335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "631 SCOTT RD",
"city": "KIMBALL",
"state": "MI",
"postal_code": "480743703",
"telephone_number": "810-367-7861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2875 HENRY ST",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480602526",
"telephone_number": "810-987-9700",
"fax_number": "810-987-9148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOGARTY",
"first_name": "HEIDI",
"middle_name": "TARA",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801068838",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Huron, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.