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General NPI Number Information
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NPI Number | 1497274633
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Entity Type | Individual
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Provider Name | MAUREEN REGINA FORD
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Gender | Female
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 23 CANDEE AVE
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City | SAYVILLE
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State | NY
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Zip | 11782-3055
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Country | US
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Telephone | 855-552-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 55 OAK ST
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City | BABYLON
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State | NY
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Zip | 11702-2329
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Country | US
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Telephone | 631-835-9741
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 041013-1
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License Number State | NY
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