Provider Demographics
NPI:1720230030
Name:FORD, WILLIAM C (PC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:FORD
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-2407
Mailing Address - Country:US
Mailing Address - Phone:718-875-7411
Mailing Address - Fax:718-643-1840
Practice Address - Street 1:2625 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2407
Practice Address - Country:US
Practice Address - Phone:718-875-7411
Practice Address - Fax:718-643-1840
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health