Provider Demographics
NPI:1720259294
Name:FORD, CHRIS REDMOND (MED, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:REDMOND
Last Name:FORD
Suffix:
Gender:F
Credentials:MED, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 BROADWAY
Mailing Address - Street 2:SUITE 213
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3223
Mailing Address - Country:US
Mailing Address - Phone:917-826-5419
Mailing Address - Fax:
Practice Address - Street 1:580 BROADWAY
Practice Address - Street 2:SUITE 213
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3223
Practice Address - Country:US
Practice Address - Phone:917-826-5419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health