MEDICARE: MARANDA COURTNEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	00001541	KY

General Provider Information

NPI Number	:	1407787385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARANDA COURTNEY LCSW

Provider Business Mailing Address
First Line	:	401 BOGLE ST STE 102
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42503-2849
Country	:	US
Telephone Number	:	606-676-0638
Fax Number	:	606-676-0789

Provider Business Practice Location Address
First Line	:	401 BOGLE ST STE 102
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42503-2849
Country	:	US
Telephone Number	:	606-676-0638
Fax Number	:	606-676-0789

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ MARANDA COURTNEY LCSW” Practice Location

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