Provider Demographics
NPI:1891190419
Name:BACH, COURTNEY ELAINE1989
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:ELAINE1989
Last Name:BACH
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 1:137 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08031-2129
Mailing Address - Country:US
Mailing Address - Phone:856-834-2007
Mailing Address - Fax:
Practice Address - Street 1:2323 BARTRAM AVE
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-1702
Practice Address - Country:US
Practice Address - Phone:856-834-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool