Individual
JULIAN FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
10 TALCOTT NOTCH RD, FARMINGTON, CT 06032-1800
(860) 679-6700
(860) 679-6736
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
002218
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004192423
—
CT
01
—
680001695
MEDICARE PIN UNDER GROUP PTAN C00025
CT
01
—
680001801
MEDICARE PIN UNDER GROUP PTAN C00060
CT
Enumeration date
07/11/2005
Last updated
07/11/2022
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