Provider Demographics
NPI:1083638340
Name:FORD, RALPH R JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:R
Last Name:FORD
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4219
Mailing Address - Country:US
Mailing Address - Phone:203-336-3661
Mailing Address - Fax:203-551-7014
Practice Address - Street 1:1057 BROAD ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4219
Practice Address - Country:US
Practice Address - Phone:203-336-3661
Practice Address - Fax:203-551-7014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001468103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral