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JOANNE FORMAN
NPI 1831460476
Counselor - Mental Health in San Rafael, CA

Active since January 12, 2012Opted out of Medicare · through Jan 1, 2028
555 NORTHGATE DR, SAN RAFAEL, CA 94903(415) 491-2059(415) 491-5750 Get Directions Write a Review

NPPES record last updated: July 3, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Joanne Forman NPPES

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

JOANNE FORMAN (NPI 1831460476) is an individual mental health provider in San Rafael, California and active in the NPI registry since January 2012. She has opted out of Medicare through January 1, 2028.

NPPES Registry Identity

NPI1831460476
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameJOANNE FORMAN
Location Address555 NORTHGATE DRSan Rafael, CA 94903-3680
Mailing Address21 Golden Hind PsgeCorte Madera, CA 94925-1907 · (415) 309-4011
Phone(415) 491-2059
Fax(415) 491-5750
Sole ProprietorYes
Enumeration DateJanuary 12, 2012
Last NPPES UpdateJuly 3, 2014
✔ NPI 1831460476 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
555 NORTHGATE DR, San Rafael, CA 94903
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Joanne Forman 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 January 1, 2024 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2024
Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

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

LISA WYNLAND LUKIANOFF
Counselor (Mental Health)
555 NORTHGATE DR, FAMILY SERVICE AGENCY OF MARIN
SAN RAFAEL, CA 94903
Marin County (415) 491-5700
FAMILY SERVICE AGENCY
Community/Behavioral Health
555 NORTHGATE DR, FAMILY SERVICE AGENCY OF MARIN
SAN RAFAEL, CA 94903
Marin County (415) 491-5700
MRS. MELISSA LEE
Counselor (Mental Health)
555 NORTHGATE DR, FAMILY SERVICE AGENCY OF MARIN
SAN RAFAEL, CA 94903
Marin County (415) 491-5700
MEGAN MCKEON
Counselor
555 NORTHGATE DR
SAN RAFAEL, CA 94903
Marin County (510) 332-9828
AMY N HARRIS
Counselor (Mental Health)
555 NORTHGATE DR, FAMILY SERVICE AGENCY OF MARIN
SAN RAFAEL, CA 94903
Marin County (415) 491-5700
MS. CARIN EBEY M.S.
Counselor (Mental Health)
555 NORTHGATE DR, FAMILY SERVICE AGENCY
SAN RAFAEL, CA 94903
Marin County (415) 491-5700
ESME IRENE GORDON MFT
Marriage & Family Therapist
555 NORTHGATE DR, FAMILY SERVICE AGENCY OF MARIN
SAN RAFAEL, CA 94903
Marin County (415) 491-5700
CORDELIA WOLF
Counselor (Mental Health)
555 NORTHGATE DR
SAN RAFAEL, CA 94903
Marin County (310) 621-4696

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 Joanne Forman's NPI number?

The NPI number for Joanne Forman is 1831460476. It was assigned to this individual provider in the NPPES registry on January 12, 2012.

Where is Joanne Forman located?

Joanne Forman practices at 555 Northgate Dr, San Rafael, CA 94903. The listed phone number is (415) 491-2059.

What is Joanne Forman's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Joanne Forman enrolled in Medicare?

No. Joanne Forman has opted out of Medicare through January 1, 2028. 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 Joanne Forman was last updated on July 3, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.