Individual provider Active NPI

Howard Wayne Forman, LCSW

  • Clinical Social Worker
  • Bellmore, NY
National Provider Identifier
1508937145
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R0261921 Issued in NY
Practice address
2631 Merrick Road
Suite 205
Bellmore, NY 11710
Phone
(516) 679-6673
Fax
(516) 679-6673
NPI assigned
Nov 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X R0261921 NY Primary

Addresses

Primary practice location

2631 Merrick Road
Suite 205
Bellmore, NY 11710

Mailing address

2631 Merrick Road
Suite 205
Bellmore, NY 11710
Phone (516) 679-6673

Other identifiers 1

IdentifierTypeStateIssuer
01644471MedicaidNY

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
I20100201000303 NY Practitioner - Clinical Social Worker 3779623020 Reassigns benefits to 1 organization
Practice locations: Levittown, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1959 Monroe Ave
North Bellmore, NY 11710-1520
Phone (516) 826-4891

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R0261921NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Nassau Guidance Counseling & Licensed Clinical Social Work Services PC Clinical CurrentSince Feb 3, 2010 Accepting new patients

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678

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": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508937145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2631 MERRICK ROAD",
            "address_2": "SUITE 205",
            "city": "BELLMORE",
            "state": "NY",
            "postal_code": "11710",
            "telephone_number": "516-679-6673",
            "fax_number": "516-679-6673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2631 MERRICK ROAD",
            "address_2": "SUITE 205",
            "city": "BELLMORE",
            "state": "NY",
            "postal_code": "11710",
            "telephone_number": "516-679-6673",
            "fax_number": "516-679-6673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "HOWARD",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R0261921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01644471",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellmore, NY

Sources for this page

Verify at the official NPI Registry.