Autumn R Forman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34012088A Issued in IN

Practice address

1003 7TH Ave
Kirkland, WA 98033-5779

Phone

(425) 658-3016

NPI assigned

Oct 14, 2019

Reactivated

Oct 9, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Autumn R Foman Former name

Medicare fee-for-service enrollment

Enrolled in IN, KY2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifespring, Inc

  dba Southern Indiana Mental Health and Guidance Center of ECI

  • Community/Behavioral Health Agency
  • Jeffersonville, IN
  • NPI 1851489942
  Medicare reassignment NPD
• Cumberland Family Medical Center Inc

  dba Cumberland Family Medical Center

  • Federally Qualified Health Center (FQHC)
  • Burkesville, KY
  • NPI 1306873500
  Medicare reassignment
• Lifespring, Inc

  dba LifeSpring Health Systems

  • Community/Behavioral Health Agency
  • Dale, IN
  • NPI 1639029283
  NPD
• Lifespring, Inc

  • Community/Behavioral Health Agency
  • Paoli, IN
  • NPI 1821565920
  NPD

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

{
    "created_epoch": "1571011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1598307357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 7TH AVE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980335779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 7TH AVE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980335779",
            "telephone_number": "425-658-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "AUTUMN",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-14",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "deactivation_date": "2025-08-27",
        "reactivation_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34012088A",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUTUMN",
            "last_name": "FOMAN",
            "middle_name": "R",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kent Fontaine
• D'Arcy Forbes
• Charla Forbus
• Ford Counseling, LLC
• Judy I Ford
• Allana Lynne Formisano
• Melissa Kay Forslund, RN, BSN, CNOR
• Vibh Forsythe Cox, PH.D.
• Tina Renee Foster
• Juliana Fotino

• Clinical Social Worker in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; 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.