Healthcare Provider Details

I. General information

NPI: 1477302479
Provider Name (Legal Business Name): ALTRANISE C HARRIS MA, LMT, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 WESTERN AVE
ALBANY NY
12203-1512
US

IV. Provider business mailing address

40 LAKESHORE DR APT 1A
WATERVLIET NY
12189-2914
US

V. Phone/Fax

Practice location:
  • Phone: 518-380-6882
  • Fax:
Mailing address:
  • Phone: 518-788-3752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number025136
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: