MEDICARE: FAIRBANKS PSYCHOTHERAPY, LLC

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

General Provider Information

NPI Number	:	1821937749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRBANKS PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	443 FOX CHASE RD
Second Line	:
City	:	CHESTER
State	:	NJ
Zip	:	07930-3122
Country	:	US
Telephone Number	:	610-304-2440
Fax Number	:

Provider Business Practice Location Address
First Line	:	443 FOX CHASE RD
Second Line	:
City	:	CHESTER
State	:	NJ
Zip	:	07930-3122
Country	:	US
Telephone Number	:	610-304-2440
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	COURTNEY FAIRBANKS
Credential	:	LCSW
Telephone Number	:	610-304-2440

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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