Healthcare Provider Details

I. General information

NPI: 1306899158
Provider Name (Legal Business Name): DOREEN MARY FORNEY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 SIMONDS RD SIRACUSA ASSOCIATES
WILLIAMSTOWN MA
01267
US

IV. Provider business mailing address

274 SUNSET HILL RD
POWNAL VT
05261
US

V. Phone/Fax

Practice location:
  • Phone: 413-458-9600
  • Fax: 413-458-4028
Mailing address:
  • Phone: 802-823-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3039
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: