Provider Demographics
NPI:1710665245
Name:AVALO, JAMES BRIAN (CASAC LEVEL 2)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BRIAN
Last Name:AVALO
Suffix:
Gender:M
Credentials:CASAC LEVEL 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DIVISION ST FL 1
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-1901
Mailing Address - Country:US
Mailing Address - Phone:305-904-2114
Mailing Address - Fax:
Practice Address - Street 1:721 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3301
Practice Address - Country:US
Practice Address - Phone:518-729-2126
Practice Address - Fax:518-729-2127
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34445101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)