Chantal Veronique Forfota, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A119000 Issued in CA

Practice address

1000 4TH St Ste 795
San Rafael, CA 94901-3120

Phone

(415) 922-9122

Fax

(415) 920-9925

NPI assigned

Jun 30, 2010

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2016 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1277856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767916800000",
    "number": "1932410388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 4TH ST STE 795",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013120",
            "telephone_number": "415-922-9122",
            "fax_number": "415-920-9925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 4TH ST STE 795",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013120",
            "telephone_number": "415-922-9122",
            "fax_number": "415-920-9925"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "582 Market St Ste 812",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941045309",
            "country_code": "US",
            "telephone_number": "415-922-9122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORFOTA",
        "first_name": "CHANTAL",
        "middle_name": "VERONIQUE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-30",
        "last_updated": "2026-01-09",
        "certification_date": "2026-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A119000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darcy Ford
• Heather Brooke Ford, PT
• Roberta Ford, P.T.
• Stacy Ford
• Foremotion Physical Therapy, P.C.
• Sharayn Forkel, RN
• Joanne Forman
• Ashley M Forrest
• Sharon Forsythe
• Kelly Foster

• Psychiatry Physician in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2026; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.