Provider Demographics
NPI:1134746308
Name:OWENS, COURTNEY MARIE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:OWENS
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 1:2421 41ST ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3252
Mailing Address - Country:US
Mailing Address - Phone:585-794-0753
Mailing Address - Fax:
Practice Address - Street 1:2421 41ST ST APT 5F
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3252
Practice Address - Country:US
Practice Address - Phone:585-794-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1407278201103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool