Provider Demographics
NPI:1073688370
Name:FORD, KATHLEEN J (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:FORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DUTTON HOME SILVER ST PO BOX 351
Mailing Address - Street 2:RIVER VALLEY SERVICES
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-262-5358
Mailing Address - Fax:860-262-5356
Practice Address - Street 1:DUTTON HOME SILVER ST
Practice Address - Street 2:RIVER VALLEY SERVICES
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-262-5358
Practice Address - Fax:860-262-5356
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0049031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical