=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952754889
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRETT CAITLIN FORD PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2016
-----------------------------------------------------
Last Update Date | 03/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 223 BYERS RD
-----------------------------------------------------
City | CHESTER SPRINGS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19425-9565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-274-0810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 CROSSINGS BLVD UNIT 1131
-----------------------------------------------------
City | ELVERSON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19520-9070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-274-0810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MF001504
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------