Provider Demographics
NPI:1073121711
Name:FATA, SAL (LMHC)
Entity Type:Individual
Prefix:
First Name:SAL
Middle Name:
Last Name:FATA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 PARK AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-2905
Mailing Address - Country:US
Mailing Address - Phone:914-255-5625
Mailing Address - Fax:
Practice Address - Street 1:685 PARK AVE FL 1
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-2905
Practice Address - Country:US
Practice Address - Phone:914-255-5625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012549104100000X
NYP105966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker