Provider Demographics
NPI:1154128098
Name:CHARDAVOYNE, CHELSEA ANN (MHC-LP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ANN
Last Name:CHARDAVOYNE
Suffix:
Gender:
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 N COUNTRY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-1518
Mailing Address - Country:US
Mailing Address - Phone:888-975-2256
Mailing Address - Fax:
Practice Address - Street 1:212 WILLOWOOD DR
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1245
Practice Address - Country:US
Practice Address - Phone:631-388-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP134155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health