Provider Demographics
NPI:1497975452
Name:COURTNEY-MONDOR, MARIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:COURTNEY-MONDOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5648
Mailing Address - Country:US
Mailing Address - Phone:978-466-3553
Mailing Address - Fax:
Practice Address - Street 1:71 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5648
Practice Address - Country:US
Practice Address - Phone:978-466-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1100331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical