JOANNE FORMAN (NPI# 1831460476) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831460476 |
| Entity Type | Individual |
| Full Name | JOANNE FORMAN |
| Practice Address |
555 Northgate Dr San Rafael CA 94903-3680 |
| Mailing Address |
21 Golden Hind Psge Corte Madera CA 94925-1907 |
| Practice Telephone | 4154912059 |
| Practice Fax Number | 4154915750 |
| Mailing Telephone | 4153094011 |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2014-07-03 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
555 NORTHGATE DR |
| City | SAN RAFAEL |
| State | CA |
| Zip Code | 94903-3680 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548270267 | Family Service Agency of Marin | Clinic/Center | 555 Northgate Dr, San Rafael, CA 94903-3680 | 2006-08-08 |
| 1851807077 | Jose Luis Tijero Jr. | Counselor | 555 Northgate Dr, San Rafael, CA 94903-3680 | 2017-12-26 |
| 1952845869 | Jessica Copeland | Counselor | 555 Northgate Dr, San Rafael, CA 94903-3680 | 2016-12-12 |
| 1235599036 | Connie Mann | Counselor | 555 Northgate Dr, Suite 200, San Rafael, CA 94903-3680 | 2016-03-07 |
| 1932595683 | Stephanie Schuman | Counselor | 555 Northgate Dr, Suite 200, San Rafael, CA 94903-3680 | 2015-04-09 |
| 1285043620 | Megan Fuller O'donnell | Counselor | 555 Northgate Dr, Suite 100 Family Service Agency of Marin, San Rafael, CA 94903-3680 | 2014-08-11 |
| 1801147103 | Marion Turner-riley | Counselor | 555 Northgate Dr, Family Service Agency of Marin, San Rafael, CA 94903-3680 | 2012-09-26 |
| 1801147616 | Teresa Michelle Vera | Counselor | 555 Northgate Dr, San Rafael, CA 94903-3680 | 2012-09-20 |
| 1629326798 | Stephanie Claire Lai | Counselor | 555 Northgate Dr, Suite 100, San Rafael, CA 94903-3680 | 2012-08-21 |
| 1619247525 | Sasha A Papovich | Counselor | 555 Northgate Dr, Family Service Agency of Marin, San Rafael, CA 94903-3680 | 2012-01-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467089524 | Christopher Sazo | Counselor | 1 St. Vincents Drive, San Rafael, CA 94903 | 2020-03-26 |
| 1134769482 | Katherine Sieger | Music Therapist | 400 Civic Center Dr. #300, San Rafael, CA 94903 | 2020-01-14 |
| 1679064836 | California In Home Care & Registry, Inc | In Home Supportive Care | 14b Mitchell Blvd, Suite B, San Rafael, CA 94903 | 2018-05-23 |
| 1922557586 | Helen Elizabeth Shamis | Marriage & Family Therapist | 30 North San Pedro, Suite #265, Beyond Hunger, San Rafael, CA 94903 | 2016-09-23 |
| 1033572771 | Henry Colbert | Counselor | 1 St. St. Vincent Drive, San Rafael, CA 94903 | 2016-03-31 |
| 1659736924 | Robyn Bloom | Marriage & Family Therapist | 4 Joseph Court, San Rafael, CA 94903 | 2015-12-30 |
| 1851760565 | Cheryl Clementson | Substance Abuse Rehabilitation Facility | 301 Smith Ranch Road, San Rafael, CA 94903 | 2015-09-23 |
| 1588043731 | Chelsea Cooney | Counselor | 1 St. Vincent's Drive, San Rafael, CA 94903 | 2015-05-20 |
| 1083002315 | Kaiser Permanente | Psychiatric Unit | 111 Smith Ranch Road, Kaiser Permanente, San Rafael, CA 94903 | 2015-01-09 |
| 1366857856 | Travel Well Corporation | Preventive Medicine | 28 Mitchell Blvd, San Rafael, CA 94903 | 2014-06-24 |
| Find all providers in zip 94903 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851830483 | Bea Ivory-chambers | Counselor | 1330 Lincoln Ave Ste 202b, San Rafael, CA 94901-2142 | 2017-02-15 |
| 1932559069 | Julia Prentice | Counselor | 920 Cresta Way, #6, San Rafael, CA 94903-5573 | 2016-06-20 |
| 1033572771 | Henry Colbert | Counselor | 1 St. St. Vincent Drive, San Rafael, CA 94903 | 2016-03-31 |
| 1033528575 | Diane Louise Ray | Counselor | 4 Majorca Ct, San Rafael, CA 94903-1520 | 2014-08-08 |
| 1487072542 | Julie Lehman | Counselor | 1717 5th Ave Ste E, San Rafael, CA 94901-1810 | 2014-04-04 |
| 1073867081 | Lisa Ann Kubiak | Counselor | 900 Mission Ave, San Rafael, CA 94901-6108 | 2012-10-30 |
| 1740530815 | Deborah Ann Spake | Counselor | 712 D St. Suite P, San Rafael, CA 94901 | 2012-09-14 |
| 1386993210 | Sarah Tischler Aikin | Counselor | 555 Northgate Drive, Suite 100, Family Service Agency of Marin, San Rafael, CA 94903-3680 | 2012-09-06 |
| 1477810182 | Amanda Gloria Jean Conn | Counselor | 980 Lincoln Ave Ste 250, San Rafael, CA 94901-8802 | 2012-04-19 |
| 1558647487 | Katherine O Bregar | Counselor | 361 Third St. Suite G, San Rafael, CA 94901 | 2011-10-24 |
| Find all providers in SAN RAFAEL | ||||
| City | SAN RAFAEL |
| Zip Code | 94903 |
Please comment or provide details below to improve the information on JOANNE FORMAN.
| 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.