Olivia Ann Goforth, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10636 Issued in CT

Practice address

49 Renee St
Bristol, CT 06010-5580

Phone

(203) 726-6811

NPI assigned

Dec 18, 2017

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

Other identifiers 1

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

Specialty

Clinical Social Worker

Education

Fordham University School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of ConnecticutGroup PAC ID 8022915677, 267 clinicians

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 and National Provider Directory roles.

• State of Connecticut

  • Adult Mental Health Clinic/Center
  • Waterbury, CT
  • NPI 1841225489
  Medicare reassignment Care Compare group NPD
• Cornell Scott Hill Health Corporation

  • Federally Qualified Health Center (FQHC)
  • New Haven, CT
  • NPI 1902921380
  Medicare reassignment NPD
• Peaceful Mind Behavioral Health & Wellness, LLC

  • Mental Health Counselor
  • Bristol, CT
  • NPI 1255926358

  Clinical

  Medicare reassignment NPD
• Restoring Hope Therapeutic Services

  • Clinical Social Worker
  • Bristol, CT
  • NPI 1861257164
  NPD Authorized official
• Peaceful Mind Behavioral Health & Wellness, LLC

  • Mental Health Counselor
  • Bristol, CT
  • NPI 1275321846

  Clinical

  NPD
• State of Connecticut

  • Skilled Nursing Facility
  • Rocky Hill, CT
  • NPI 1205951662
  NPD

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

{
    "created_epoch": "1513555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1871009563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 RENEE ST",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060105580",
            "telephone_number": "203-726-6811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 RENEE ST",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060105580",
            "telephone_number": "203-726-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOFORTH",
        "first_name": "OLIVIA",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-18",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "10636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008089787",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Glasser, MD
• Jennifer Glasson, PHARMD
• Nicole Glick
• Megan Smith Godard, O.D.
• Sandra Jeanne Godin, LPC
• Bryan Douglas Goldberg, MD
• Jeffrey R Goldberg, MD
• Jeffrey Goldschlager, D.C.
• Diana Patricia Gonzalez, AU.D., CCC-A
• Jelisa Gonzalez, LMSW

• Clinical Social Worker in Bristol, CT
• Providers in Bristol, 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 Mar 1, 2024; 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.