Provider Demographics
NPI:1497743900
Name:FORD, BRIAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 WOODBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2032
Mailing Address - Country:US
Mailing Address - Phone:732-321-1686
Mailing Address - Fax:732-321-3608
Practice Address - Street 1:35 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2578
Practice Address - Country:US
Practice Address - Phone:732-321-1686
Practice Address - Fax:732-321-3608
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ SC 007741041C0700X
NYR065228-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ641838Medicare ID - Type Unspecified