Provider Demographics
NPI:1033284732
Name:MASSARO, DOMINICK (CDC III)
Entity Type:Individual
Prefix:
First Name:DOMINICK
Middle Name:
Last Name:MASSARO
Suffix:
Gender:M
Credentials:CDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 FAIRLAWN PKWY
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-2307
Mailing Address - Country:US
Mailing Address - Phone:518-357-2909
Mailing Address - Fax:518-357-2937
Practice Address - Street 1:2925 HAMBURG ST
Practice Address - Street 2:ST PETERS ADDICTION RECOVERY CENTER
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-4343
Practice Address - Country:US
Practice Address - Phone:518-357-2909
Practice Address - Fax:518-357-2937
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)