Provider Demographics
NPI:1003925710
Name:FORD, ELLEN WHITE (LCSW, MSW, MPH)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:WHITE
Last Name:FORD
Suffix:
Gender:F
Credentials:LCSW, MSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 MIRANDA AVE
Mailing Address - Street 2:VAPAHCS SOCIAL WORK SERVICE, 122 PA
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1207
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-852-3455
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:VAPAHCS SOCIAL WORK SERVICE, 122 PA
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-852-3455
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA259311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker