Healthcare Provider Details

I. General information

NPI: 1750202669
Provider Name (Legal Business Name): COURTNEY ELIZABETH CONDORI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12073 TECH RD
SILVER SPRING MD
20904-7873
US

IV. Provider business mailing address

15721 EDGEWOOD DR
DUMFRIES VA
22025-1727
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-1315
  • Fax:
Mailing address:
  • Phone: 301-593-1315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017137
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: