Provider Demographics
NPI:1720390115
Name:DUNLAP, CORTNEY (EDD, LPC)
Entity Type:Individual
Prefix:DR
First Name:CORTNEY
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BRAINARD RD
Mailing Address - Street 2:STE 105
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-3202
Mailing Address - Country:US
Mailing Address - Phone:860-306-9238
Mailing Address - Fax:860-470-3286
Practice Address - Street 1:90 BRAINARD RD
Practice Address - Street 2:STE 105
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-3202
Practice Address - Country:US
Practice Address - Phone:860-306-9238
Practice Address - Fax:860-470-3286
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2466101YP2500X
CT4991824780101YS0200X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008049143Medicaid