MS. KRISTEN MARIE FORMAN (NPI# 1285105403) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285105403 |
| Entity Type | Individual |
| Full Name | MS. KRISTEN MARIE FORMAN |
| Other Name | MS. KRISTEN GREANY |
| Credential | LCSW |
| Practice Address |
The Koch Center, P.C. 71 Franklin Tpke, Ste. 8 Waldwick NJ 07463 |
| Practice Telephone | 2015416420 |
| Practice Fax Number | 2016701214 |
| Mailing Telephone | 2015416420 |
| Mailing Fax Number | 2016701214 |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
44SC05624500 | NJ | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992750335 | Kristen Carter Forman | Dermatology | 1617 Westcliff Dr, Newport Beach, CA 92660-5524 | 2006-05-24 |
| Street Address |
THE KOCH CENTER, P.C. 71 FRANKLIN TPKE, STE. 8 |
| City | WALDWICK |
| State | NJ |
| Zip Code | 07463 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104384460 | Life Opportunities Unlimited | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 28 Cleveland Ave, Waldwick, NJ 07463 | 2019-03-06 |
| 1083123970 | Emily Navarro | Dietitian, Registered | 26 Cleveland Ave, Waldwick, NJ 07463 | 2017-09-24 |
| 1760916340 | Sensory Taekwondo of Waldwick | Behavioral Analyst | 140 Hopper Ave, Waldwick, NJ 07463 | 2017-04-20 |
| 1205291176 | Eastern Christian Children's Retreat | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 148 Wyckoff Avenue, Waldwick, NJ 07463 | 2015-12-21 |
| 1225456593 | Mina Hanna | Podiatrist | 171 Franklin Tpke Ste 200, Waldwick, NJ 07463 | 2014-04-02 |
| 1811282569 | Marion Elaine Troise | Massage Therapist | 3-4 Vernon Ct., Waldwick, NJ 07463 | 2011-06-10 |
| 1154595197 | Sports Medicine Center of Bergen, Pa | Physical Therapist | 136 Hopper Ave., Waldwick, NJ 07463 | 2008-04-22 |
| 1326223777 | Raymond M Younghans | Physical Therapist | 136 Hopper Avenue, Waldwick, NJ 07463 | 2008-01-04 |
| 1841412228 | Armi Aura D Hernandez | Physical Therapist | 171 North Franklin Tpke., Waldwick, NJ 07463 | 2007-05-03 |
| 1720102239 | Diane Stark Suda | Social Worker | 10 Franklin Turnpike, Second Floor, Waldwick, NJ 07463 | 2007-03-19 |
| Find all providers in zip 07463 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770183725 | Catherine Friedl Hartmann | Social Worker | 17 Cleveland Ave, Waldwick, NJ 07463-1622 | 2020-10-29 |
| 1194332585 | Marian Couceiro | Social Worker | 38 Douglas St, Waldwick, NJ 07463-2424 | 2020-09-29 |
| 1447780226 | Psychological Counseling and Empowerment | Social Worker | 71 Franklin Tpke Ste 1-2, Waldwick, NJ 07463-1800 | 2017-06-14 |
| 1609200914 | Nancy Dykstra-powers | Social Worker | 71 Franklin Tpke Ste 4, Waldwick, NJ 07463-1851 | 2013-08-23 |
| 1902248503 | Michelle Marie Dailey | Social Worker | 27 Campbell St, Waldwick, NJ 07463-2403 | 2013-07-24 |
| 1578785580 | Conrad Neil De Master | Social Worker | 71 Franklin Turnpike, Suite 2-4, Waldwick, NJ 07463-1851 | 2007-05-02 |
| 1720102239 | Diane Stark Suda | Social Worker | 10 Franklin Turnpike, Second Floor, Waldwick, NJ 07463 | 2007-03-19 |
| 1114950367 | S and D Psychotherapy Associates, LLC | Social Worker | 85 Hopper Ave, Waldwick, NJ 07463-1517 | 2006-07-09 |
| 1568981991 | Maryclaire Mena, Lcsw | Social Worker | 85 Hopper Ave, Waldwick, NJ 07463-1517 | 2017-09-18 |
| 1114370657 | Psychological Consulting and Therapy Inc | Social Worker | 71 Franklin Tpke, Suite 1-2, Waldwick, NJ 07463-1851 | 2016-07-20 |
| Find all providers in WALDWICK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.