Active NPI
Kristine Fornaby, LCSW
- Clinical Social Worker
- Guilford, CT
National Provider Identifier
1649726951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 009371
- Practice address
- 35 Boston St
Guilford, CT 06437-2817 - Phone
- (914) 329-8964
- NPI assigned
- Aug 27, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 | 009371 | CT | Primary |
Addresses
Primary practice location
35 Boston St
Guilford, CT 06437-2817
Mailing address
35 Boston St
Guilford, CT 06437-2817
Phone (914) 329-8964
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170327002161 | CT | Practitioner - Clinical Social Worker | 3577848951 | Practice locations: Guilford, CT |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2011
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
35 Boston St
Guilford, CT 06437-2817
Phone (914) 329-8964
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009371 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547769600000",
"number": "1649726951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35 BOSTON ST",
"city": "GUILFORD",
"state": "CT",
"postal_code": "064372817",
"telephone_number": "914-329-8964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35 BOSTON ST",
"city": "GUILFORD",
"state": "CT",
"postal_code": "064372817",
"telephone_number": "914-329-8964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORNABY",
"first_name": "KRISTINE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-27",
"last_updated": "2019-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "009371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Guilford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; 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.