Provider Demographics
NPI:1003004458
Name:KRILEY, COURTNEY ANNE (LSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANNE
Last Name:KRILEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2776
Mailing Address - Country:US
Mailing Address - Phone:814-861-3300
Mailing Address - Fax:814-861-5163
Practice Address - Street 1:1315 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2776
Practice Address - Country:US
Practice Address - Phone:814-861-3300
Practice Address - Fax:814-861-5163
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW010641L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker