Healthcare Provider Details

I. General information

NPI: 1104353846
Provider Name (Legal Business Name): COURTNEY CHAPMAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DERBY ST STE 206
HINGHAM MA
02043-3786
US

IV. Provider business mailing address

8 GILMAN ST # 1
SOMERVILLE MA
02145-4011
US

V. Phone/Fax

Practice location:
  • Phone: 585-469-8899
  • Fax:
Mailing address:
  • Phone: 585-469-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127956
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: