Healthcare Provider Details

I. General information

NPI: 1275201436
Provider Name (Legal Business Name): COURTNEY LIMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 WASHBURN AVE
CAMBRIDGE MA
02140-1128
US

IV. Provider business mailing address

132 1/2 OXFORD ST APT 9
CAMBRIDGE MA
02140-1564
US

V. Phone/Fax

Practice location:
  • Phone: 161-766-1570
  • Fax:
Mailing address:
  • Phone: 805-440-3523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: