Provider Demographics
NPI:1043371891
Name:FLEISHER, COURTNEY LANDAU (PHD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LANDAU
Last Name:FLEISHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:PATRICK 408
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-4923
Mailing Address - Fax:802-847-8961
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:PATRICK 408
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-4923
Practice Address - Fax:802-847-8961
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007011103TC0700X
UT7805018-2501103TC2200X
VT80416103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019704Medicaid
NH34200275Medicaid