Provider Demographics
NPI:1285764522
Name:LABARGE, ANDREW STEPHEN (PHD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:STEPHEN
Last Name:LABARGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:834 KENWOOD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9601
Mailing Address - Country:US
Mailing Address - Phone:518-439-1641
Mailing Address - Fax:518-439-1625
Practice Address - Street 1:834 KENWOOD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9601
Practice Address - Country:US
Practice Address - Phone:518-439-1641
Practice Address - Fax:518-439-1625
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014976103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist