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General NPI Number Information
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NPI Number | 1922368844
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Entity Type | Individual
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Provider Name | MATTHEW AMORE RASO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 11/30/2018
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Provider Practice Location Address
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Address Line | 12 CENTURY HILL DR
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City | LATHAM
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State | NY
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Zip | 12110-2123
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Country | US
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Telephone | 518-302-2812
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Fax | 518-309-6593
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Provider Business Mailing Address
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Address Line | 50 CENTURY DR
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City | BALLSTON SPA
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State | NY
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Zip | 12020-4224
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Country | US
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Telephone | 518-368-3462
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 019522-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 019522-1
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License Number State | NY
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