Provider Demographics
NPI:1790334985
Name:PURDY, COURTNEY KRISTEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:KRISTEN
Last Name:PURDY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 N OCEAN BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6424
Mailing Address - Country:US
Mailing Address - Phone:954-616-5088
Mailing Address - Fax:
Practice Address - Street 1:3600 N OCEAN BLVD FL 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6424
Practice Address - Country:US
Practice Address - Phone:954-616-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10588103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist