Provider Demographics
NPI:1275705246
Name:FORD, SUSANNAH (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:
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 1:142 OCEAN HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-1123
Mailing Address - Country:US
Mailing Address - Phone:207-347-9357
Mailing Address - Fax:
Practice Address - Street 1:131 OCEAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3649
Practice Address - Country:US
Practice Address - Phone:207-799-1873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-30
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC57081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical