Provider Demographics
NPI:1306899158
Name:FORNEY, DOREEN MARY (LMHC)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:MARY
Last Name:FORNEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 SUNSET HILL RD
Mailing Address - Street 2:
Mailing Address - City:POWNAL
Mailing Address - State:VT
Mailing Address - Zip Code:05261
Mailing Address - Country:US
Mailing Address - Phone:802-823-5709
Mailing Address - Fax:
Practice Address - Street 1:681 SIMONDS RD
Practice Address - Street 2:SIRACUSA ASSOCIATES
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267
Practice Address - Country:US
Practice Address - Phone:413-458-9600
Practice Address - Fax:413-458-4028
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3039103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling