MEDICARE: BEVERLY FORD-GREENE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	103K00000X

General Provider Information

NPI Number	:	1114319217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY FORD-GREENE

Provider Business Mailing Address
First Line	:	5521 PEMBERTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-2525
Country	:	US
Telephone Number	:	215-365-4092
Fax Number	:

Provider Business Practice Location Address
First Line	:	5521 PEMBERTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-2525
Country	:	US
Telephone Number	:	215-365-4092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	02/26/2015

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Directions to “ BEVERLY FORD-GREENE ” Practice Location

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