Active NPI
Peter Forkner, PHD
- Clinical Psychologist
- Waltham, MA
National Provider Identifier
1124518956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 9320
- Practice address
- 175 Forest Street
Counseling Center, Callahan BLDG, 2ND FLR
Waltham, MA 02452 - Phone
- (781) 891-2274
- NPI assigned
- May 17, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 9320 | MA | Primary |
Addresses
Primary practice location
175 Forest Street
Counseling Center, Callahan BLDG, 2ND FLR
Waltham, MA 02452
Mailing address
175 Forest Street
Counseling Center, Callahan BLDG, 2ND FLR
Waltham, MA 02452
Phone (781) 891-2274
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9320 | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526515200000",
"number": "1124518956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 FOREST STREET",
"address_2": "COUNSELING CENTER, CALLAHAN BLDG, 2ND FLR",
"city": "WALTHAM",
"state": "MA",
"postal_code": "02452",
"telephone_number": "781-891-2274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 FOREST STREET",
"address_2": "COUNSELING CENTER, CALLAHAN BLDG, 2ND FLR",
"city": "WALTHAM",
"state": "MA",
"postal_code": "02452",
"telephone_number": "781-891-2274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORKNER",
"first_name": "PETER",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-17",
"last_updated": "2018-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "9320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.