Healthcare Provider Details

I. General information

NPI: 1982148102
Provider Name (Legal Business Name): COURTNEY FORD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SILSBEE ST
LYNN MA
01901-1404
US

IV. Provider business mailing address

28 SUMMIT AVE
LYNN MA
01902-1316
US

V. Phone/Fax

Practice location:
  • Phone: 781-599-0110
  • Fax:
Mailing address:
  • Phone: 781-599-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number220147
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121931
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: