Provider Demographics
NPI:1902252604
Name:FOSSELLA, ALDO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALDO
Middle Name:
Last Name:FOSSELLA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 OAKDALE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5046
Mailing Address - Country:US
Mailing Address - Phone:718-727-1796
Mailing Address - Fax:718-605-3615
Practice Address - Street 1:495 OAKDALE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5046
Practice Address - Country:US
Practice Address - Phone:718-727-1796
Practice Address - Fax:718-605-3615
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR024446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health