Provider Demographics
NPI:1942894779
Name:GOOD, COURTNEY NICOLE (LSW)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:NICOLE
Last Name:GOOD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 S UNION RD
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7661
Mailing Address - Country:US
Mailing Address - Phone:201-317-4759
Mailing Address - Fax:
Practice Address - Street 1:2336 S UNION RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7661
Practice Address - Country:US
Practice Address - Phone:201-317-4759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06122000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker