Provider Demographics
NPI:1598470411
Name:FLEURY, CORTNIE (LPCA)
Entity Type:Individual
Prefix:
First Name:CORTNIE
Middle Name:
Last Name:FLEURY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PINE CT
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1734
Mailing Address - Country:US
Mailing Address - Phone:203-747-6798
Mailing Address - Fax:
Practice Address - Street 1:12 PINE CT
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1734
Practice Address - Country:US
Practice Address - Phone:203-747-6798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLPCA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health