Provider Demographics
NPI:1073624847
Name:COURTNEY, JOHN H (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:H
Last Name:COURTNEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:(327 MAIN STREET SUITE C)
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-0586
Mailing Address - Country:US
Mailing Address - Phone:518-943-1517
Mailing Address - Fax:518-731-9146
Practice Address - Street 1:327 MAIN ST
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1823
Practice Address - Country:US
Practice Address - Phone:518-943-1517
Practice Address - Fax:518-731-9146
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR020310-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02026864Medicaid
NY02026864Medicaid
NYN09641Medicare ID - Type Unspecified