Provider Demographics
NPI:1215988993
Name:LEDFORD, EARL (LCSW)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:
Last Name:LEDFORD
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 1:1600 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 201U
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4149
Mailing Address - Country:US
Mailing Address - Phone:321-213-7370
Mailing Address - Fax:321-241-4939
Practice Address - Street 1:1600 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 201U
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4149
Practice Address - Country:US
Practice Address - Phone:321-213-7370
Practice Address - Fax:321-241-4939
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00050081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1503ZMedicare PIN