Provider Demographics
NPI:1407901952
Name:FORNI, SARAH LESLIE (MA, IMF)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:LESLIE
Last Name:FORNI
Suffix:
Gender:F
Credentials:MA, IMF
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:NIEMI
Other - Last Name:FORNI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2790 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9696
Mailing Address - Country:US
Mailing Address - Phone:707-963-9369
Mailing Address - Fax:707-963-9527
Practice Address - Street 1:2790 SPRING ST
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9696
Practice Address - Country:US
Practice Address - Phone:707-963-9369
Practice Address - Fax:707-963-9527
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 42625106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist