The Forum at San Diego Brainworks, Inc.

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

THE FORUM AT SAN DIEGO BRAINWORKS, INC.

Practice address

5820 Oberlin Dr Ste 203
San Diego, CA 92121-3744

Phone

(858) 247-3162

NPI assigned

Apr 14, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Shahan Suzmeyan

Title

Compliance

Phone

(213) 924-6442

Specialties & licenses 2

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joel Z New

  • Religious Nonmedical Practitioner
  • San Diego, CA
  • NPI 1912796830
  NPD
• Stacey Odell, LCSW

  • Clinical Social Worker
  • Waco, TX
  • NPI 1659014983
  NPD (past)

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

{
    "created_epoch": "1649894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649894400000",
    "number": "1215670542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5820 OBERLIN DR STE 203",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213744",
            "telephone_number": "858-247-3162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5820 OBERLIN DR STE 203",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213744",
            "telephone_number": "858-247-3162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FORUM AT SAN DIEGO BRAINWORKS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-14",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A",
        "authorized_official_last_name": "SUZMEYAN",
        "authorized_official_first_name": "SHAHAN",
        "authorized_official_title_or_position": "COMPLIANCE",
        "authorized_official_telephone_number": "213-924-6442",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• The Hand Center
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• Adolescent and Children Mental Health Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Adolescent and Children Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.