Healthcare Provider Details

I. General information

NPI: 1699685461
Provider Name (Legal Business Name): YVETTE FORNISHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 M ST SE
WASHINGTON DC
20003-3799
US

IV. Provider business mailing address

13644 OTONO DR
MOUNT AIRY MD
21771-5952
US

V. Phone/Fax

Practice location:
  • Phone: 202-826-3131
  • Fax:
Mailing address:
  • Phone: 240-899-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200004757
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: