Joanne Forman

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

555 Northgate Dr
San Rafael, CA 94903-3680

Phone

(415) 491-2059

Fax

(415) 491-5750

NPI assigned

Jan 12, 2012

Last updated

Jul 3, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Albani Group Family and Child Therapy Inc. Dba the Albani Group

  • Marriage & Family Therapist
  • Mill Valley, CA
  • NPI 1407445471
  NPD (past)

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

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404345600000",
    "number": "1831460476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 GOLDEN HIND PSGE",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251907",
            "telephone_number": "415-309-4011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 NORTHGATE DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949033680",
            "telephone_number": "415-491-2059",
            "fax_number": "415-491-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "JOANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-12",
        "last_updated": "2014-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roberta Ford, P.T.
• Stacy Ford
• Foremotion Physical Therapy, P.C.
• Chantal Veronique Forfota, M.D.
• Sharayn Forkel, RN
• Ashley M Forrest
• Sharon Forsythe
• Kelly Foster
• Therese Bernadette Foster, BA
• Lisa Ann Fowler

• Mental Health Counselor in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.