Provider Demographics
NPI:1336207463
Name:VARESCHI, COURTNEY GAIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:GAIL
Last Name:VARESCHI
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 1:3 DUNDEE PARK DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3751
Mailing Address - Country:US
Mailing Address - Phone:978-475-3590
Mailing Address - Fax:
Practice Address - Street 1:3 DUNDEE PARK DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3751
Practice Address - Country:US
Practice Address - Phone:978-475-3590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300911Medicaid
MAW51373Medicare ID - Type Unspecified