Individual
KELLYANNE FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
30 S VALLEY RD, PAOLI, PA 19301-1450
(484) 615-3155
Mailing address
2227 S 10TH ST, PHILADELPHIA, PA 19148-3048
(732) 691-0558
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL06738700
NJ
Other
Enumeration date
12/13/2021
Last updated
12/13/2021
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