Provider Demographics
NPI:1457765331
Name:BEIRNE, COURTNEY MICHELE (BA)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:MICHELE
Last Name:BEIRNE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7609 58TH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-5208
Mailing Address - Country:US
Mailing Address - Phone:917-548-4779
Mailing Address - Fax:
Practice Address - Street 1:7609 58TH RD
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-5208
Practice Address - Country:US
Practice Address - Phone:917-548-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst