Provider Demographics
NPI:1780993626
Name:AXON, COURTNEY JOANNE (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:JOANNE
Last Name:AXON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:JOANNE
Other - Last Name:IVANOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 CORDAGE PARK CIR STE 326
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7320
Mailing Address - Country:US
Mailing Address - Phone:508-746-0215
Mailing Address - Fax:
Practice Address - Street 1:36 CORDAGE PARK CIR STE 326
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7320
Practice Address - Country:US
Practice Address - Phone:508-746-0215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1224941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical