MEDICARE: KENYA ANITA FORD

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	103TC0700X	Clinical Psychologist	200001355	DC

General Provider Information

NPI Number	:	1699498386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYA ANITA FORD

Provider Business Mailing Address
First Line	:	5557 BALTIMORE AVE STE 500-2224
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-1922
Country	:	US
Telephone Number	:	443-639-4411
Fax Number	:

Provider Business Practice Location Address
First Line	:	5557 BALTIMORE AVE STE 500-2224
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-1922
Country	:	US
Telephone Number	:	443-639-4411
Fax Number	:

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

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	07/12/2023

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