Brooke Fortenberry, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

11002 Issued in CT

Practice address

240 Indian River Rd Ste C
Orange, CT 06477-3649

Phone

(203) 497-3867

Fax

(203) 298-0494

NPI assigned

Apr 6, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Impact Health Psych PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Orange, CT
  • NPI 1730781022
  Medicare reassignment NPD
• Impact Health P.C.

  • Nurse Practitioner
  • Orange, CT
  • NPI 1730694316
  Medicare reassignment

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1700415379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 INDIAN RIVER RD STE C",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064773649",
            "telephone_number": "203-497-3867",
            "fax_number": "203-298-0494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 INDIAN RIVER RD STE C",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064773649",
            "telephone_number": "203-497-3867",
            "fax_number": "203-298-0494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTENBERRY",
        "first_name": "BROOKE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-06",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "11002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Watkins Fischer, PHD
• Emma Fitzgibbon
• Sarah Flanagan, OT
• Sarah Elizabeth Forer
• Erica L Forselius, MA, LPC, NCC
• Marcus Frank, LCSW, CFSW
• Sydney Ruth Fray, FNP
• Synthia Fulcher, ST
• Emily Ann Gaetano
• Tyler Gaetano

• Clinical Social Worker in Orange, CT
• Providers in Orange, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.