Active NPI
Bryan Forrester, PHD
- Clinical Psychologist
- San Jose, CA
National Provider Identifier
1255683199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 28794
- Practice address
- 2400 Moorpark Ave
300
San Jose, CA 95128 - Phone
- (408) 975-2730
- NPI assigned
- Oct 2, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY28794 | CA | |
| Clinical Psychologist | 103TC0700X | 28794 | CA | Primary |
Addresses
Primary practice location
2400 Moorpark Ave
300
San Jose, CA 95128
Mailing address
2400 Moorpark Ave
300
San Jose, CA 95128-2631
Phone (408) 975-2730
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY28794 | CA | MD | Clinical Psychologist |
| 28794 | CA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Good Roots Psychotherapy | Past | Accepting new patients | |
| Encore Clinical Consultation | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- NPI 1235773177
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- Pleasant Hill, CA
- NPI 1235086976
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535587200000",
"number": "1255683199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 MOORPARK AVE",
"address_2": "300",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951282631",
"telephone_number": "408-975-2730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 MOORPARK AVE",
"address_2": "300",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "95128",
"telephone_number": "408-975-2730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORRESTER",
"first_name": "BRYAN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-02",
"last_updated": "2018-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY28794",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "28794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.