Healthcare Provider Details

I. General information

NPI: 1033038989
Provider Name (Legal Business Name): DEREK M BRESLIN MHC-LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1182 TROY SCHENECTADY RD STE 204
LATHAM NY
12110-1000
US

IV. Provider business mailing address

29 TAMARACK LN
NISKAYUNA NY
12309-1845
US

V. Phone/Fax

Practice location:
  • Phone: 518-400-5180
  • Fax:
Mailing address:
  • Phone: 518-728-7796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP143290
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: