Active NPI
Jennifer Elizabeth Fornelli, MS, LMFTA
- Marriage & Family Therapist
- Avon, IN
National Provider Identifier
1376774323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 85000015A
- Practice address
- 6655 E US Highway 36
Avon, IN 46123-8923 - Phone
- (317) 272-3330
- Fax
- (317) 272-3331
- NPI assigned
- Aug 6, 2009
- Last updated
- Aug 6, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Marriage & Family Therapist | 106H00000X | 85000015A | IN | Primary |
Addresses
Primary practice location
6655 E US Highway 36
Avon, IN 46123-8923
Mailing address
9421 Benchmark Dr
Apt. C
Indianapolis, IN 46240-1290
Phone (501) 593-9465
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85000015A | IN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249516800000",
"number": "1376774323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9421 BENCHMARK DR",
"address_2": "APT. C",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462401290",
"telephone_number": "501-593-9465",
"fax_number": "010-101-0101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6655 E US HIGHWAY 36",
"city": "AVON",
"state": "IN",
"postal_code": "461238923",
"telephone_number": "317-272-3330",
"fax_number": "317-272-3331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORNELLI",
"first_name": "JENNIFER",
"middle_name": "ELIZABETH",
"name_prefix": "Mrs.",
"credential": "MS, LMFTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-06",
"last_updated": "2009-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "IN",
"license": "85000015A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Avon, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.