Healthcare Provider Details

I. General information

NPI: 1083983704
Provider Name (Legal Business Name): COURTNEY ALLISON PATTI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2011
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130A E MAIN ST
FRONT ROYAL VA
22630-3163
US

IV. Provider business mailing address

130A E MAIN ST
FRONT ROYAL VA
22630-3163
US

V. Phone/Fax

Practice location:
  • Phone: 402-520-3005
  • Fax: 540-252-3125
Mailing address:
  • Phone: 540-252-0300
  • Fax: 540-252-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16871
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: