Healthcare Provider Details

I. General information

NPI: 1083426837
Provider Name (Legal Business Name): JASMINE FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 WHEELERS FARMS RD
MILFORD CT
06461-1847
US

IV. Provider business mailing address

110 COURT ST STE 3B
CROMWELL CT
06416-1273
US

V. Phone/Fax

Practice location:
  • Phone: 203-877-0300
  • Fax:
Mailing address:
  • Phone: 860-613-9930
  • Fax: 860-613-9952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: