Forrest Kublick, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1660 Issued in OR

Practice address

1942 NW Kearney St
Ste 14
Portland, OR 97209-1463

Phone

(503) 318-7736

Fax

(503) 287-4355

NPI assigned

Jul 13, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521590400000",
    "number": "1043419609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1942 NW KEARNEY ST",
            "address_2": "STE 14",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091463",
            "telephone_number": "503-318-7736",
            "fax_number": "503-287-4355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1942 NW KEARNEY ST",
            "address_2": "STE 14",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091463",
            "telephone_number": "503-318-7736",
            "fax_number": "503-287-4355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBLICK",
        "first_name": "FORREST",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-13",
        "last_updated": "2018-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278037",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Kubetz
• Sharon A Kubik, DNP, ACNP-BC, CCRN
• Angela Lyn Kubin, MSW
• Amanda Kubisch
• Joshua Kubischta
• Laura; Kubly
• Natsuki Kubotera, PHARMD
• Cobalt Jace Kubu
• Ryan Steve Kucala, OD
• Christina Marie Kucera, MSW, LCSW

• Clinical Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.