Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Justin David Forman, BS

Individual provider Mental Health Counselor · NPI 1477700938

Mr. Justin David Forman, BS is a Clinical Psychologist in Santa Rosa, California. Qualified in 2013, 13 years ago. Accepts Medicare assignment and offers telehealth.

Years since qualifying
13
In the registry since
2008
What do these letters mean?
BS — Bachelor of Science
An undergraduate science degree.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

320 10th St Ste 200
Santa Rosa, CA 95401-5291
Phone: (707) 536-7804
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X

Record details

NPI number1477700938
Entity typeIndividual (Type 1)
GenderMale
Credentials BS
Sole proprietorNo
NPI enumeratedAugust 26, 2008
Last updated in NPPESMarch 14, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Santa Rosa