Active NPI
Jillian Foraker, LCSW
- Clinical Social Worker
- North Chesterfield, VA
National Provider Identifier
1174211775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904015134
- Practice address
- 707 N Courthouse Rd
North Chesterfield, VA 23236-4045 - Phone
- (804) 924-2236
- NPI assigned
- May 1, 2023
- Last updated
- May 1, 2023
- 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 | 0904015134 | VA | Primary |
Addresses
Primary practice location
707 N Courthouse Rd
North Chesterfield, VA 23236-4045
Mailing address
1604 Queens Point Dr
Henrico, VA 23238-3943
Phone (804) 833-8864
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 2, 2024 through Jan 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0904015134 | VA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682899200000",
"number": "1174211775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1604 QUEENS POINT DR",
"city": "HENRICO",
"state": "VA",
"postal_code": "232383943",
"telephone_number": "804-833-8864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 N COURTHOUSE RD",
"city": "NORTH CHESTERFIELD",
"state": "VA",
"postal_code": "232364045",
"telephone_number": "804-924-2236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORAKER",
"first_name": "JILLIAN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-01",
"last_updated": "2023-05-01",
"certification_date": "2023-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904015134",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Chesterfield, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.