Provider Demographics
NPI:1821601220
Name:SUMNER, KORTNEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KORTNEY
Middle Name:
Last Name:SUMNER
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 1:369 WASHINGTON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1869
Mailing Address - Country:US
Mailing Address - Phone:857-200-9813
Mailing Address - Fax:857-226-8772
Practice Address - Street 1:369 WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1869
Practice Address - Country:US
Practice Address - Phone:857-200-9813
Practice Address - Fax:857-226-8772
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2245991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical