Healthcare Provider Details

I. General information

NPI: 1104736073
Provider Name (Legal Business Name): KATHY ANN STALEY-ROSS MHC-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 MADISON AVE
ALBANY NY
12208-3301
US

IV. Provider business mailing address

721 MADISON AVE
ALBANY NY
12208-3301
US

V. Phone/Fax

Practice location:
  • Phone: 518-729-2126
  • Fax: 518-729-2127
Mailing address:
  • Phone: 518-729-2126
  • Fax: 518-729-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP142185
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: