Provider Demographics
NPI:1316206246
Name:BUSHNELL, COURTNEY LEIGH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LEIGH
Last Name:BUSHNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ELM ST
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4105
Mailing Address - Country:US
Mailing Address - Phone:860-388-9656
Mailing Address - Fax:860-388-9463
Practice Address - Street 1:130 ELM ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4105
Practice Address - Country:US
Practice Address - Phone:860-388-9656
Practice Address - Fax:860-388-9463
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-12
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT79551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical