Provider Demographics
NPI:1619368701
Name:AKSDAL FALCO, COURTNEY FARRELL (LCSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:FARRELL
Last Name:AKSDAL FALCO
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:PSC 466
Mailing Address - Street 2:BOX 18
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96595
Mailing Address - Country:US
Mailing Address - Phone:315-370-4421
Mailing Address - Fax:
Practice Address - Street 1:PSC 466
Practice Address - Street 2:BOX 18
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96595
Practice Address - Country:US
Practice Address - Phone:315-370-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055306001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical