Healthcare Provider Details

I. General information

NPI: 1346888328
Provider Name (Legal Business Name): CHRISTINA MARY RULISON LCAT, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

IV. Provider business mailing address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-5884
  • Fax:
Mailing address:
  • Phone: 518-626-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number000746-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: