Provider Demographics
NPI:1700048162
Name:FORD, PATRICIA DYMPNA (LCACD, CCDP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DYMPNA
Last Name:FORD
Suffix:
Gender:F
Credentials:LCACD, CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CORBIN DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5403
Mailing Address - Country:US
Mailing Address - Phone:203-662-1111
Mailing Address - Fax:203-655-0023
Practice Address - Street 1:10 CORBIN DR
Practice Address - Street 2:SUITE 4
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-5403
Practice Address - Country:US
Practice Address - Phone:203-662-1111
Practice Address - Fax:203-655-0023
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health