Provider Demographics
NPI:1619598455
Name:FAULKNER, CORTNNEY DANIELLE
Entity Type:Individual
Prefix:
First Name:CORTNNEY
Middle Name:DANIELLE
Last Name:FAULKNER
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 1:1 VETERANS WAY APT 210
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-2264
Mailing Address - Country:US
Mailing Address - Phone:717-433-3989
Mailing Address - Fax:
Practice Address - Street 1:51 LYTE
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551
Practice Address - Country:US
Practice Address - Phone:717-871-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No104100000XBehavioral Health & Social Service ProvidersSocial Worker