Provider Demographics
NPI:1598113383
Name:BETCHER, COURTNEY MARIE
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:MARIE
Last Name:BETCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 DOVECOTE LN
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-2410
Mailing Address - Country:US
Mailing Address - Phone:631-617-3358
Mailing Address - Fax:
Practice Address - Street 1:208 DOVECOTE LN
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2410
Practice Address - Country:US
Practice Address - Phone:631-617-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker