Active NPI
Jennifer Forman, PH.D
- Clinical Psychologist
- Redwood City, CA
National Provider Identifier
1366816233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 21151
- Practice address
- 2000 Broadway St
Ste. 271
Redwood City, CA 94063-1802 - Phone
- (650) 224-2790
- NPI assigned
- Nov 16, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 | 21151 | CA | Primary |
Addresses
Primary practice location
2000 Broadway St
Ste. 271
Redwood City, CA 94063-1802
Mailing address
2000 Broadway St
Ste. 271
Redwood City, CA 94063-1802
Phone (650) 224-2790
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 30, 2023 through Oct 30, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21151 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447632000000",
"number": "1366816233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 BROADWAY ST",
"address_2": "STE. 271",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940631802",
"telephone_number": "650-224-2790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 BROADWAY ST",
"address_2": "STE. 271",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940631802",
"telephone_number": "650-224-2790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMAN",
"first_name": "JENNIFER",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-11-16",
"last_updated": "2015-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "21151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redwood City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.