Provider Demographics
NPI:1477301729
Name:FORNISHI, NJI CLARKSON
Entity type:Individual
Prefix:
First Name:NJI
Middle Name:CLARKSON
Last Name:FORNISHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24260 WHITE WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2156
Mailing Address - Country:US
Mailing Address - Phone:619-753-8024
Mailing Address - Fax:
Practice Address - Street 1:24260 WHITE WILLOW AVE
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-2156
Practice Address - Country:US
Practice Address - Phone:619-753-8024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA850811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical