Provider Demographics
NPI:1093332892
Name:FORD, BRIANNA B (LCSW-C)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:B
Last Name:FORD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:B
Other - Last Name:BEARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 THOMAS JOHNSON DR STE J
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4893
Mailing Address - Country:US
Mailing Address - Phone:301-414-2300
Mailing Address - Fax:
Practice Address - Street 1:77 THOMAS JOHNSON DR STE J
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4893
Practice Address - Country:US
Practice Address - Phone:301-414-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24156104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD38-3876389Medicaid