Individual provider Active NPI

Jennifer Leigh Forte, LCSW

  • Clinical Social Worker
  • Ithaca, NY
National Provider Identifier
1114280625
Registry record updated Feb 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
09065501 Issued in NY
Practice address
201 E Green St
Ithaca, NY 14850-5635
Phone
(516) 474-2918
NPI assigned
Jun 19, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 024772 NY
Clinical Social Worker 1041C0700X 09065501 NY Primary

Addresses

Primary practice location

201 E Green St
Ithaca, NY 14850-5635

Mailing address

138 Bundy Rd
Ithaca, NY 14850-9252
Phone (516) 474-2918

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210325000160 NY Practitioner - Clinical Social Worker 4486061199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tompkins CountyGroup PAC ID 0143210443, 19 clinicians

Practice addresses (Care Compare)

201 E Green St
Ithaca, NY 14850-5635
Phone (607) 274-6200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
09065501NYMDClinical Social Worker
024772NYMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Tompkins County CurrentSince Dec 23, 2020 Accepting new patients

Locations

201 E Green St
Ithaca, NY 14850
Phone (607) 274-6200

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.

NPI Registry JSON

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612742400000",
    "number": "1114280625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 BUNDY RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148509252",
            "telephone_number": "516-474-2918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E GREEN ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505635",
            "telephone_number": "516-474-2918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTE",
        "first_name": "JENNIFER",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-19",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "024772",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "09065501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

Verify at the official NPI Registry.