Provider Demographics
NPI:1912651894
Name:DENEVI, COURTNEY (BCBA, LMSW, MED)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:DENEVI
Suffix:
Gender:F
Credentials:BCBA, LMSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 E THOMAS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8220
Mailing Address - Country:US
Mailing Address - Phone:602-957-2507
Mailing Address - Fax:602-957-2510
Practice Address - Street 1:1001 N CENTRAL AVE STE 610
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1935
Practice Address - Country:US
Practice Address - Phone:623-210-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-18370104100000X
AZ1-21-54491103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker