Provider Demographics
NPI:1417493099
Name:FORD MORANCY, KERRY SUZANNE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:SUZANNE
Last Name:FORD MORANCY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1547
Mailing Address - Country:US
Mailing Address - Phone:443-285-1749
Mailing Address - Fax:
Practice Address - Street 1:1320 W 41ST ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1547
Practice Address - Country:US
Practice Address - Phone:443-285-1749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD216491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical