MEDICARE: DR. JOSEPH ALLEN 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	0904002422	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	195633	OTHER	IL	COMPSYCH
2	11412343	OTHER	VA	CAQH
3	088479	OTHER	VA	ANTHEM BC/BS

General Provider Information

NPI Number	:	1619950235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ALLEN FORD LCSW

Provider Business Mailing Address
First Line	:	1605 SWORD CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-8117
Country	:	US
Telephone Number	:	757-479-2314
Fax Number	:	757-622-8585

Provider Business Practice Location Address
First Line	:	2412 E VIRGINIA BEACH BLVD
Second Line	:	SUITE D
City	:	NORFOLK
State	:	VA
Zip	:	23504-3628
Country	:	US
Telephone Number	:	757-622-7474
Fax Number	:	757-622-8585

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/09/2007

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