Healthcare Provider Details

I. General information

NPI: 1114403664
Provider Name (Legal Business Name): COURTNEY ANNE COMLY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 ORMOND AVE
DREXEL HILL PA
19026-2621
US

IV. Provider business mailing address

1205 ORMOND AVE
DREXEL HILL PA
19026-2621
US

V. Phone/Fax

Practice location:
  • Phone: 215-208-6251
  • Fax:
Mailing address:
  • Phone: 215-208-6251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS018427
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: