Samantha Forman

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

139159 Issued in CA

Practice address

166 Santa Clara Ave Ste 205
Oakland, CA 94610-1323

Phone

(510) 601-1929

Fax

(510) 660-1194

NPI assigned

Apr 26, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Earth Circles Counseling Center

  • Mental Health Counselor
  • Oakland, CA
  • NPI 1821137381
  NPD (past)

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

{
    "created_epoch": "1650931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683676800000",
    "number": "1518601392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 FAWN DR",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949601159",
            "telephone_number": "415-717-9405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 SANTA CLARA AVE STE 205",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946101323",
            "telephone_number": "510-601-1929",
            "fax_number": "510-660-1194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "SAMANTHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-26",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "0020808",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CO",
            "license": "0014462",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "139159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna N Foreman
• Bonnie Forer, M.A.
• Forerehab Therapy Services LLC
• Monica Forero
• Eszter Forgacs
• Elizabeth Fornero
• Laverne E Forney-Williams, R.N
• Lisa Suzette Forrest
• Martin Forst
• Brynnen Forster, MD

• Marriage & Family Therapist in Oakland, CA
• Providers in Oakland, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; 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.