Provider Demographics
NPI:1538760616
Name:YOUNG-FORD, CHARDANAY ARIEL SAMANTHA
Entity type:Individual
Prefix:MRS
First Name:CHARDANAY
Middle Name:ARIEL SAMANTHA
Last Name:YOUNG-FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARDANAY
Other - Middle Name:ARIEL SAMANTHA
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-2016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:716-842-4069
Practice Address - Street 1:951 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2116
Practice Address - Country:US
Practice Address - Phone:716-884-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor