Provider Demographics
NPI:1477965457
Name:ANDERSON, COURTNEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MAPLE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1715
Mailing Address - Country:US
Mailing Address - Phone:732-610-4953
Mailing Address - Fax:
Practice Address - Street 1:103 MAPLE AVE STE 102
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1715
Practice Address - Country:US
Practice Address - Phone:732-610-4953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00592700103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent