MEDICARE: COURTNEY PLANK LCSW PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1912602210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURTNEY PLANK LCSW PLLC

Provider Business Mailing Address
First Line	:	209 BEDFORD BANKSVILLE RD
Second Line	:
City	:	BEDFORD
State	:	NY
Zip	:	10506-1918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 BEDFORD BANKSVILLE RD
Second Line	:
City	:	BEDFORD
State	:	NY
Zip	:	10506-1918
Country	:	US
Telephone Number	:	617-697-9471
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. COURTNEY PLANK RAULT
Credential	:	LCSW
Telephone Number	:	617-697-9471

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	04/04/2023

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