Provider Demographics
NPI:1952654600
Name:VALERO-BRUST, AMELIA J (MS, CAS)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:J
Last Name:VALERO-BRUST
Suffix:
Gender:F
Credentials:MS, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1831
Mailing Address - Country:US
Mailing Address - Phone:518-366-6946
Mailing Address - Fax:
Practice Address - Street 1:20 W LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1831
Practice Address - Country:US
Practice Address - Phone:518-366-6946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool