Provider Demographics
NPI:1912015512
Name:FORNIAS, BARBARA BJORK (LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:BJORK
Last Name:FORNIAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7336 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-6609
Mailing Address - Country:US
Mailing Address - Phone:225-924-4638
Mailing Address - Fax:225-769-2088
Practice Address - Street 1:7336 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-6609
Practice Address - Country:US
Practice Address - Phone:225-924-4638
Practice Address - Fax:225-769-2088
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X101Medicare ID - Type Unspecified