Healthcare Provider Details

I. General information

NPI: 1629140850
Provider Name (Legal Business Name): MAUREEN D FORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LIBERTY ST
NEW PALTZ NY
12561-4316
US

IV. Provider business mailing address

4 LIBERTY ST
NEW PALTZ NY
12561-4316
US

V. Phone/Fax

Practice location:
  • Phone: 845-340-4000
  • Fax: 845-340-4070
Mailing address:
  • Phone: 845-340-4000
  • Fax: 845-340-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR054397-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: