Healthcare Provider Details

I. General information

NPI: 1396086815
Provider Name (Legal Business Name): ALLISON LISS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 BURDETT AVE
TROY NY
12180-2466
US

IV. Provider business mailing address

601 TROY SCHENECTADY RD # 1069
LATHAM NY
12110-2813
US

V. Phone/Fax

Practice location:
  • Phone: 518-270-3300
  • Fax:
Mailing address:
  • Phone: 518-374-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number597703
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: