| Doctor Name: | DOMINICK MASSARO |
| NPI Number: | 1033284732 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CDC III |
| License Number: | |
| Business Practice Address: | 2925 Hamburg St St Peters Addiction Recovery Center Schenectady, NY - 123034343 |
| Business Phone Number: | 5183572909 |
| Business Fax Number: | 5183572937 |
| Mailing Address: | 2209 Fairlawn Pkwy, SCHENECTADY |
| State: | NY |
| Postal Code: | 123092307 |
| Phone Number: | 5183572909 |
| Fax Number: | 5183572937 |
| NPI Enumeration Date: | 11/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |