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General NPI Number Information
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NPI Number | 1073121711
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Entity Type | Individual
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Provider Name | SAL FATA LMHC
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Gender | Male
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 685 PARK AVE FL 1
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City | ALBANY
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State | NY
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Zip | 12208-2905
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Country | US
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Telephone | 914-255-5625
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Fax |
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Provider Business Mailing Address
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Address Line | 685 PARK AVE FL 1
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City | ALBANY
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State | NY
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Zip | 12208-2905
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Country | US
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Telephone | 914-255-5625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 012549
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P105966
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License Number State | NY
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