Healthcare Provider Details

I. General information

NPI: 1225703002
Provider Name (Legal Business Name): REBECCA LYNN SANDA FORNACIARI LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 WILLARD AVE
CHEVY CHASE MD
20815-3690
US

IV. Provider business mailing address

39A INDUSTRIAL PARK RD
PLYMOUTH MA
02360-4868
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax:
Mailing address:
  • Phone: 508-830-1444
  • Fax: 508-830-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: