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MS. KRISTEN MARIE FORMAN LCSW
NPI 1285105403
Social Worker - Clinical in Ridgewood, NJ

Active since December 16, 2018Opted out of Medicare · through Oct 1, 2026
115 PINE STREET, SUITE 303, RIDGEWOOD, NJ 07450(201) 564-0597(201) 670-1214 Get Directions Write a Review

NPPES record last updated: July 6, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 6, 2022, Dec 16, 2018 (2 updates tracked since 2018).

About Ms. Kristen Marie Forman Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. KRISTEN MARIE FORMAN LCSW (NPI 1285105403) is an individual clinical provider in Ridgewood, New Jersey, licensed in New Jersey (44SC05624500) and active in the NPI registry since December 2018. She has opted out of Medicare through October 1, 2026.

NPPES Registry Identity

NPI1285105403
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameMS. KRISTEN MARIE FORMANCredential: LCSW
Location Address115 PINE STREET, SUITE 303Ridgewood, NJ 07450
Mailing Address115 Pine Street, Suite 303Ridgewood, NJ 07450 · (201) 564-0597 · Fax (201) 670-1214
Phone(201) 564-0597
Fax(201) 670-1214
Sole ProprietorNo
Enumeration DateDecember 16, 2018
Last NPPES UpdateJuly 6, 20222 updates tracked since enumeration
NPPES CertifiedJuly 6, 2022
✔ NPI 1285105403 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in NJ · 44SC05624500
Definition
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.
115 PINE STREET, Ridgewood, NJ 07450
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Other Names 1

Former Name (1)Ms. Kristen Greany Lsw

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Ms. Kristen Marie Forman Lcsw has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 1, 2018 through October 1, 2026.

Opt-Out Effective DateOctober 1, 2018
Opt-Out In Effect ThroughOctober 1, 2026Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. SUSAN JOAN DONNELLY LCSW
Social Worker
115 PINE STREET
RIDGEWOOD, NJ 07450
Bergen County (201) 447-0364
JASMINE ALONI-COHN L.C.S.W.
Social Worker (Clinical)
115 PINE STREET
RIDGEWOOD, NJ 07450
Bergen County (201) 652-6843

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kristen Forman's NPI number?

The NPI number for Kristen Forman is 1285105403. It was assigned to this individual provider in the NPPES registry on December 16, 2018. The provider is also known as Ms. Kristen Greany Lsw.

Where is Kristen Forman located?

Kristen Forman practices at 115 Pine Street Suite 303, Ridgewood, NJ 07450. The listed phone number is (201) 564-0597.

What is Kristen Forman's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Kristen Forman enrolled in Medicare?

No. Kristen Forman has opted out of Medicare through October 1, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Kristen Forman was last updated on July 6, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.