Provider Demographics
NPI:1891166724
Name:DE THOMAS, COURTNEY ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ANNE
Last Name:DE THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 GERARD AVE
Mailing Address - Street 2:NEW YORK CITY CHILDREN'S CENTER- BRONX CAMPUS
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5239
Mailing Address - Country:US
Mailing Address - Phone:718-742-6185
Mailing Address - Fax:718-742-6016
Practice Address - Street 1:595 GERARD AVE
Practice Address - Street 2:NEW YORK CITY CHILDREN'S CENTER- BRONX CAMPUS
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5239
Practice Address - Country:US
Practice Address - Phone:718-742-6185
Practice Address - Fax:718-742-6016
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019267103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical