Provider Demographics
NPI:1972311488
Name:CHARTRAND, TYRANNY ALASKA (LMSW)
Entity type:Individual
Prefix:
First Name:TYRANNY
Middle Name:ALASKA
Last Name:CHARTRAND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5491 STATE ROUTE 410
Mailing Address - Street 2:
Mailing Address - City:CASTORLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13620-2311
Mailing Address - Country:US
Mailing Address - Phone:315-955-5244
Mailing Address - Fax:
Practice Address - Street 1:628 MARY ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-2419
Practice Address - Country:US
Practice Address - Phone:315-272-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health