Provider Demographics
NPI:1093874927
Name:KURTH-FORD, GREGORY TODD (MA, CAS)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:TODD
Last Name:KURTH-FORD
Suffix:
Gender:M
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5744
Mailing Address - Country:US
Mailing Address - Phone:410-404-9058
Mailing Address - Fax:
Practice Address - Street 1:1645 LIBERTY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6521
Practice Address - Country:US
Practice Address - Phone:410-404-9058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional