Healthcare Provider Details

I. General information

NPI: 1316825219
Provider Name (Legal Business Name): COURTNEY GUMSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ANTUOSHAN 6TH STREET
SHENZHEN GUANGDONG
518000
CN

IV. Provider business mailing address

3 NOTTINGHAM WAY S
CLIFTON PARK NY
12065-1716
US

V. Phone/Fax

Practice location:
  • Phone: 240-371-8714
  • Fax:
Mailing address:
  • Phone: 518-877-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17377
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: