Provider Demographics
NPI:1598856692
Name:FORTI, SANDRA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:J
Last Name:FORTI
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 1:3736 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3523
Mailing Address - Country:US
Mailing Address - Phone:614-262-6296
Mailing Address - Fax:614-262-6085
Practice Address - Street 1:3400 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-1500
Practice Address - Country:US
Practice Address - Phone:614-262-6296
Practice Address - Fax:614-262-6085
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5410103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFOCP24937Medicare ID - Type UnspecifiedMEDICARE