MARK D FORMAN PHD
NPI 1427354414
Psychologist in San Jose, CA

Active since February 08, 2011PECOS Enrolled
1769 PARK AVE, SUITE 110, SAN JOSE, CA 95126(408) 841-7443 Get Directions Write a Review

NPPES record last updated: February 8, 2011. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Mark D Forman Phd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARK D FORMAN PHD (NPI 1427354414) is an individual psychologist in San Jose, California, licensed in California (PSY23310) and active in the NPI registry since February 2011. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1427354414
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameMARK D FORMANCredential: PHD
Location Address1769 PARK AVE, SUITE 110San Jose, CA 95126-2029
Mailing Address1769 Park Ave, Suite 110San Jose, CA 95126-2029 · (408) 841-7443
Sole ProprietorYes
Enumeration DateFebruary 8, 2011
NPI 1427354414 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in CA · PSY23310
Definition

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

1769 PARK AVE, San Jose, CA 95126

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Mark D Forman Phd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Psychologist
1769 PARK AVE, SUITE 210
SAN JOSE, CA 95126
Marriage & Family Therapist
1769 PARK AVE, SUITE 210
SAN JOSE, CA 95126
Behavior Analyst
1769 PARK AVE, SUITE 250
SAN JOSE, CA 95126
Behavior Analyst
1769 PARK AVE, SUITE 250
SAN JOSE, CA 95126
Behavior Analyst
1769 PARK AVE, 250
SAN JOSE, CA 95126
Marriage & Family Therapist
1769 PARK AVE, SUITE 210
SAN JOSE, CA 95126
Marriage & Family Therapist
1769 PARK AVE, SUITE 240
SAN JOSE, CA 95126

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1427354414, enumerated as an "individual" on February 08, 2011.

The provider is located at 1769 PARK AVE SUITE 110 SAN JOSE, CA 95126 and the phone number is (408) 841-7443.

Psychologist with taxonomy code 103T00000X.

The provider might be accepting Accepts: Providence Health Plan. Please consult your insurance carrier or call the provider to verify.