Provider Demographics
NPI:1083967129
Name:EZZO, COURTNEY MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MARIE
Last Name:EZZO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 PEEBLES ST
Mailing Address - Street 2:APT C
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-3244
Mailing Address - Country:US
Mailing Address - Phone:412-482-2588
Mailing Address - Fax:
Practice Address - Street 1:465 PEEBLES ST
Practice Address - Street 2:APT C
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-3244
Practice Address - Country:US
Practice Address - Phone:412-482-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA006574101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional