MEDICARE: ERIN FORD LMFT

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	106H00000X	Marriage & Family Therapist	72703	CA

General Provider Information

NPI Number	:	1528499449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN FORD LMFT

Provider Business Mailing Address
First Line	:	PO BOX 695
Second Line	:
City	:	WATER MILL
State	:	NY
Zip	:	11976-0695
Country	:	US
Telephone Number	:	917-514-8857
Fax Number	:

Provider Business Practice Location Address
First Line	:	1032 HEAD OF POND RD
Second Line	:
City	:	WATER MILL
State	:	NY
Zip	:	11976-2535
Country	:	US
Telephone Number	:	917-514-8857
Fax Number	:

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

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	09/17/2021

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