Healthcare Provider Details

I. General information

NPI: 1265347991
Provider Name (Legal Business Name): OUR HOLDING SPACE NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BROADWAY # R
ALBANY NY
12207-2922
US

IV. Provider business mailing address

418 BROADWAY # R
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 929-214-6351
  • Fax:
Mailing address:
  • Phone: 929-214-6351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANA DENARIS
Title or Position: OWNER
Credential: PMHNP
Phone: 929-214-6351