Provider Demographics
NPI:1922747609
Name:FORD, DARYLENE REBECCA
Entity Type:Individual
Prefix:MRS
First Name:DARYLENE
Middle Name:REBECCA
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 E SOLIDELL ST
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-3252
Mailing Address - Country:US
Mailing Address - Phone:504-351-6808
Mailing Address - Fax:
Practice Address - Street 1:3028 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3808
Practice Address - Country:US
Practice Address - Phone:504-948-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator