Provider Demographics
NPI:1881996403
Name:DU MOND, COURTNEY ELIZABETH (PHD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:DU MOND
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 1:2 SOUTH ST
Mailing Address - Street 2:STE 204
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3833
Mailing Address - Country:US
Mailing Address - Phone:315-370-9964
Mailing Address - Fax:315-370-9964
Practice Address - Street 1:2 SOUTH ST
Practice Address - Street 2:STE 204
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3833
Practice Address - Country:US
Practice Address - Phone:315-370-9964
Practice Address - Fax:315-370-9964
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
NY019038-1103TC0700X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ4000426232Medicare PIN