1194965772 NPI number — MS. TRACYAVON SHARON-ESTELLE FORD LCSW-R

Table of content: MS. TRACYAVON SHARON-ESTELLE FORD LCSW-R (NPI 1194965772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194965772 NPI number — MS. TRACYAVON SHARON-ESTELLE FORD LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORD
Provider First Name:
TRACYAVON
Provider Middle Name:
SHARON-ESTELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194965772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
244 5TH AVENUE
Provider Second Line Business Mailing Address:
SUITE T215
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-317-5296
Provider Business Mailing Address Fax Number:
718-989-9240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
244 5TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE T215
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-317-5296
Provider Business Practice Location Address Fax Number:
718-989-9240
Provider Enumeration Date:
02/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R071782 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com