Provider Demographics
NPI:1043513567
Name:FORNABIA, CHRISTINE ELISABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ELISABETH
Last Name:FORNABIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 GREENWICH ST
Mailing Address - Street 2:825
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2204
Mailing Address - Country:US
Mailing Address - Phone:917-805-3376
Mailing Address - Fax:
Practice Address - Street 1:88 GREENWICH ST
Practice Address - Street 2:825
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2204
Practice Address - Country:US
Practice Address - Phone:917-805-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018668103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical