Provider Demographics
NPI:1477302479
Name:HARRIS, ALTRANISE C (MA, LMT, CD)
Entity type:Individual
Prefix:
First Name:ALTRANISE
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, LMT, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LAKESHORE DR APT 1A
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2914
Mailing Address - Country:US
Mailing Address - Phone:518-788-3752
Mailing Address - Fax:
Practice Address - Street 1:485 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1512
Practice Address - Country:US
Practice Address - Phone:518-380-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025136225700000X
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist