MEDICARE: MS. LINDA RUTH FORD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R0396335-1	NY

General Provider Information

NPI Number	:	1215012638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA RUTH FORD LCSW

Provider Business Mailing Address
First Line	:	119-07 229 STREET
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411
Country	:	US
Telephone Number	:	718-978-6075
Fax Number	:	718-558-4338

Provider Business Practice Location Address
First Line	:	11907 229TH ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-2205
Country	:	US
Telephone Number	:	718-978-6075
Fax Number	:	718-558-4339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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