Provider Demographics
NPI:1982349981
Name:FORNESS, CANDICE (REIKI MASTER TEACHER)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:FORNESS
Suffix:
Gender:F
Credentials:REIKI MASTER TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W 17TH ST # 3A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5306
Mailing Address - Country:US
Mailing Address - Phone:347-645-0521
Mailing Address - Fax:
Practice Address - Street 1:150 W 30TH ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4148
Practice Address - Country:US
Practice Address - Phone:347-645-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker