Healthcare Provider Details

I. General information

NPI: 1073930582
Provider Name (Legal Business Name): COURTNEY TAYLOR LCSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 EVERETT AVE APT B
WYCKOFF NJ
07481-1940
US

IV. Provider business mailing address

252 EVERETT AVE APT B
WYCKOFF NJ
07481-1940
US

V. Phone/Fax

Practice location:
  • Phone: 201-800-4414
  • Fax:
Mailing address:
  • Phone: 201-546-4213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00261100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05719600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC19142
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: