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General NPI Number Information
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NPI Number | 1285764522
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Entity Type | Individual
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Provider Name | ANDREW STEPHEN LABARGE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 834 KENWOOD AVE SUITE 3
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City | SLINGERLANDS
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State | NY
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Zip | 12159-9601
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Country | US
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Telephone | 518-439-1641
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Fax | 518-439-1625
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Provider Business Mailing Address
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Address Line | 834 KENWOOD AVE SUITE 3
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City | SLINGERLANDS
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State | NY
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Zip | 12159-9601
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Country | US
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Telephone | 518-439-1641
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Fax | 518-439-1625
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 014976
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License Number State | NY
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