Provider Demographics
NPI:1750060463
Name:FORD, CHARITY D (LMSW)
Entity type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:D
Last Name:FORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:DR
Other - First Name:CHARITY
Other - Middle Name:DENISE
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HARLEY
Mailing Address - Street 1:PO BOX 4106
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-0106
Mailing Address - Country:US
Mailing Address - Phone:203-507-0845
Mailing Address - Fax:
Practice Address - Street 1:11 EASTON ST
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-5015
Practice Address - Country:US
Practice Address - Phone:203-507-0845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8082104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker