Provider Demographics
NPI:1548647837
Name:FORNEY, EVA BEATRIX
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:BEATRIX
Last Name:FORNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6613 W CORTEZ ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-3128
Mailing Address - Country:US
Mailing Address - Phone:623-332-1472
Mailing Address - Fax:
Practice Address - Street 1:5023 W ONYX AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-2426
Practice Address - Country:US
Practice Address - Phone:623-937-0917
Practice Address - Fax:623-937-0917
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker