Active NPI
Kristen Marie Forman, LCSW
- Clinical Social Worker
- Ridgewood, NJ
National Provider Identifier
1285105403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 44SC05624500
- Practice address
- 115 Pine Street
Suite 303
Ridgewood, NJ 07450 - Phone
- (201) 564-0597
- Fax
- (201) 670-1214
- NPI assigned
- Dec 16, 2018
- 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 | 44SC05624500 | NJ | Primary |
Addresses
Primary practice location
115 Pine Street
Suite 303
Ridgewood, NJ 07450
Mailing address
115 Pine Street
Suite 303
Ridgewood, NJ 07450
Phone (201) 564-0597
Other names 1
- Ms. Kristen Greany
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2018 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44SC05624500 | NJ | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657065600000",
"number": "1285105403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 PINE STREET",
"address_2": "SUITE 303",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "07450",
"telephone_number": "201-564-0597",
"fax_number": "201-670-1214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 PINE STREET",
"address_2": "SUITE 303",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "07450",
"telephone_number": "201-564-0597",
"fax_number": "201-670-1214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMAN",
"first_name": "KRISTEN",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-16",
"last_updated": "2022-07-06",
"certification_date": "2022-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NJ",
"license": "44SC05624500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KRISTEN",
"last_name": "GREANY",
"prefix": "MS.",
"credential": "LSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Ridgewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; 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.