Healthcare Provider Details

I. General information

NPI: 1326448275
Provider Name (Legal Business Name): TRINITY ALLIANCE OF THE CAPITAL REGION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LINCOLN SQUARE
ALBANY NY
12202
US

IV. Provider business mailing address

15 TRINITY PLACE
ALBANY NY
12202
US

V. Phone/Fax

Practice location:
  • Phone: 518-487-4117
  • Fax: 518-487-4117
Mailing address:
  • Phone: 518-449-5155
  • Fax: 518-689-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number140910049
License Number StateNY

VIII. Authorized Official

Name: MR. HARRIS MARSHALL OBERLANDER
Title or Position: CEO
Credential: LCSW-R
Phone: 518-449-5155