Katrina Forman, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW17881 Issued in FL

Practice address

4302 Hollywood Blvd # 127
Hollywood, FL 33021-6635

Phone

(954) 505-0554

Fax

(954) 505-0554

NPI assigned

Jul 27, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Clinical Social Worker

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

La Sagrada Familia Medical Center IncGroup PAC ID 8224428826, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: katrinaforman@tdh.allscriptsdirect.net

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.

• La Sagrada Familia Medical Center Inc

  dba La Sagrada Familia Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miami, FL
  • NPI 1508468869

  Community/Behavioral Health

  Medicare reassignment Care Compare group NPD
• A & B Counseling Services LLC

  • Adult Mental Health Clinic/Center
  • Fort Lauderdale, FL
  • NPI 1508327628
  Medicare reassignment NPD
• Direct Access Counseling & Supportive Services, LLC

  dba Direct Access Counseling and Supportive Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Arcadia, FL
  • NPI 1679011449

  Addiction (Substance Use Disorder)

  Medicare reassignment NPD
• Medication Assisted Recovery Institute, LLC

  • Addiction Medicine (Preventive Medicine) Physician
  • Boca Raton, FL
  • NPI 1154967891

  Mental Health

  Medicare reassignment NPD
• Mtca Psychological Services P.a.

  • Clinical Psychologist
  • North Miami Beach, FL
  • NPI 1740552322
  Medicare reassignment NPD
• Quality BHS Florida, LLC

  dba Quality Behavioral Health Services

  • Clinical Social Worker
  • Tampa, FL
  • NPI 1689297541
  Medicare reassignment NPD
• Blue Moon Senior Counseling

  • Clinical Social Worker
  • Plainfield, IL
  • NPI 1205129186

  FL

  Medicare reassignment NPD
• Access Medical Care Inc.

  • Community/Behavioral Health Agency
  • Pembroke Pines, FL
  • NPI 1457949281
  Medicare reassignment
• M&M Behavioral Health Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miami, FL
  • NPI 1033072715
  Medicare reassignment
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Mental Health

  NPD
• A & B Counseling LLC

  • In Home Supportive Care Agency
  • Fort Lauderdale, FL
  • NPI 1316400203
  NPD (past)
• Ultima Rehab-FL LLC

  • Geriatric Physical Therapist
  • North Fort Myers, FL
  • NPI 1053970194
  NPD (past)

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

{
    "created_epoch": "1311724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681430400000",
    "number": "1447538269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4302 HOLLYWOOD BLVD STE 127",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330216635",
            "telephone_number": "954-505-0554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4302 HOLLYWOOD BLVD # 127",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330216635",
            "telephone_number": "954-505-0554",
            "fax_number": "954-505-0554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "KATRINA",
        "name_prefix": "Ms.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-27",
        "last_updated": "2023-04-14",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW17881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Fontenelle
• Bianca Foote, M.S., OTR/L
• For Pedz Sake Inc
• Ronald Andrew Ford, M.D.
• Johanna M. Forero-Moylan, CRNA
• Nathaniel Hamilton Forman, M.D.
• Concepcion Fornaris Caballero, APRN
• Nanella Fornoni
• Anita Forrest
• Patricia Forsyth, ARNP

• Clinical Social Worker in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.