Provider Demographics
NPI:1760691554
Name:MARTIN FORD, CECILIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:
Last Name:MARTIN FORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CECILIA
Other - Middle Name:MARTIN
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:50 E 96TH ST
Mailing Address - Street 2:APT 4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0810
Mailing Address - Country:US
Mailing Address - Phone:212-369-5588
Mailing Address - Fax:212-369-5588
Practice Address - Street 1:50 E 96TH ST
Practice Address - Street 2:APT 4A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0810
Practice Address - Country:US
Practice Address - Phone:212-369-5588
Practice Address - Fax:212-369-5588
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009195-1103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis