Healthcare Provider Details

I. General information

NPI: 1952654600
Provider Name (Legal Business Name): AMELIA J VALERO-BRUST M.S., C.A.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W LAWRENCE ST
ALBANY NY
12206-1831
US

IV. Provider business mailing address

20 W LAWRENCE ST
ALBANY NY
12206-1831
US

V. Phone/Fax

Practice location:
  • Phone: 518-366-6946
  • Fax:
Mailing address:
  • Phone: 518-366-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: