Provider Demographics
NPI:1972116275
Name:PETTY, BRITTANY FORD (LICSW)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:FORD
Last Name:PETTY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1231
Mailing Address - Country:US
Mailing Address - Phone:774-239-2692
Mailing Address - Fax:
Practice Address - Street 1:473 SALISBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1231
Practice Address - Country:US
Practice Address - Phone:774-239-2692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2255731041C0700X
MA1251981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical