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General NPI Number Information
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NPI Number | 1295954238
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Entity Type | Organization
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Legal Business Name | BROOKSIDE COUNSELING ASSOCIATES
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1444 MASSACHUSETTS AVE SUITE 208
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City | TROY
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State | NY
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Zip | 12180-1600
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Country | US
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Telephone | 518-274-2336
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Fax | 518-274-2336
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Provider Business Mailing Address
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Address Line | 1444 MASSACHUSETTS AVE SUITE 208
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City | TROY
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State | NY
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Zip | 12180-1600
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Country | US
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Telephone | 518-274-2336
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Fax | 518-274-2336
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. ALFRED M VOLO
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Credential | PH.D.
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Telephone | 518-274-2336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 010837
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License Number State | NY
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