Provider Demographics
NPI:1306203625
Name:VILLERE, COURTNEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:VILLERE
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 1:1518 JAMES RD STE 600N
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2515
Mailing Address - Country:US
Mailing Address - Phone:617-935-6604
Mailing Address - Fax:
Practice Address - Street 1:3535 MARKET ST
Practice Address - Street 2:SUITE 600N
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3309
Practice Address - Country:US
Practice Address - Phone:215-746-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-17
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017774103TC2200X
103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent