MEDICARE: SANDRA NICOLE FORD LICSW

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	0904010042	VA
2	1041C0700X	Clinical Social Worker	LC50081449	DC
3	1041C0700X	Clinical Social Worker	25681	MD
4	1041C0700X	Clinical Social Worker	CSW004885	GA

General Provider Information

NPI Number	:	1740695378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA NICOLE FORD LICSW

Provider Business Mailing Address
First Line	:	1638 R ST NW STE 310
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-6446
Country	:	US
Telephone Number	:	202-505-1850
Fax Number	:	202-888-0213

Provider Business Practice Location Address
First Line	:	1638 R ST NW STE 310
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-6446
Country	:	US
Telephone Number	:	202-505-1850
Fax Number	:	202-888-0213

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

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	10/09/2024

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Directions to “ SANDRA NICOLE FORD LICSW” Practice Location

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