Healthcare Provider Details

I. General information

NPI: 1932941663
Provider Name (Legal Business Name): JARED VALLEAU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NEW KARNER RD STE 2
ALBANY NY
12205-3840
US

IV. Provider business mailing address

401 NEW KARNER RD STE 2
ALBANY NY
12205-3840
US

V. Phone/Fax

Practice location:
  • Phone: 518-426-2600
  • Fax:
Mailing address:
  • Phone: 518-426-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125778
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: