Provider Demographics
NPI:1174997852
Name:FORD, NOEMI (PSYD)
Entity type:Individual
Prefix:DR
First Name:NOEMI
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E RANDOLPH ST STE 5100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-6528
Mailing Address - Country:US
Mailing Address - Phone:773-983-1487
Mailing Address - Fax:
Practice Address - Street 1:200 E RANDOLPH ST STE 5100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-6528
Practice Address - Country:US
Practice Address - Phone:773-983-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078907103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA079545OtherLICENSE