Provider Demographics
NPI:1811657893
Name:FORD, DEONTE LEROY (LCSW)
Entity type:Individual
Prefix:
First Name:DEONTE
Middle Name:LEROY
Last Name:FORD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 CAUGHEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4098
Mailing Address - Country:US
Mailing Address - Phone:814-480-9197
Mailing Address - Fax:
Practice Address - Street 1:3910 CAUGHEY RD STE 200
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4098
Practice Address - Country:US
Practice Address - Phone:412-219-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-18
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104100000X
PACW0249091041C0700X
PASW138846104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical