Healthcare Provider Details

I. General information

NPI: 1881466399
Provider Name (Legal Business Name): COURTNEY KUSHNER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1182 CHENANGO ST
BINGHAMTON NY
13901-1653
US

IV. Provider business mailing address

1182 CHENANGO ST
BINGHAMTON NY
13901-1653
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-6904
  • Fax: 607-722-4123
Mailing address:
  • Phone: 607-772-6904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number119450-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: