Provider Demographics
NPI:1073689170
Name:DESOUZA, DESILVA, FORD, LLC
Entity Type:Organization
Organization Name:DESOUZA, DESILVA, FORD, LLC
Other - Org Name:DYNAMIC PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:513-922-1660
Mailing Address - Street 1:5936 GLENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2009
Mailing Address - Country:US
Mailing Address - Phone:513-922-1660
Mailing Address - Fax:513-922-6230
Practice Address - Street 1:999 LILA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1617
Practice Address - Country:US
Practice Address - Phone:513-831-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC8233101YP2500X
OHI-00015681041C0700X
OH350660322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0182770Medicaid
OH0981184Medicaid
OH0981184Medicaid