Healthcare Provider Details

I. General information

NPI: 1992021398
Provider Name (Legal Business Name): ANDREW JOHN FABOZZI LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NEW SCOTLAND AVE
ALBANY NY
12208-3409
US

IV. Provider business mailing address

75 NEW SCOTLAND AVE
ALBANY NY
12208-3409
US

V. Phone/Fax

Practice location:
  • Phone: 518-447-9611
  • Fax: 518-426-2902
Mailing address:
  • Phone: 518-447-9611
  • Fax: 518-426-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number031644
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: