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General NPI Number Information
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NPI Number | 1306203625
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Entity Type | Individual
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Provider Name | COURTNEY VILLERE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2016
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 3535 MARKET ST SUITE 600N
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3309
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Country | US
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Telephone | 215-746-3784
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Fax |
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Provider Business Mailing Address
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Address Line | 1518 JAMES RD STE 600N
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City | WYNNEWOOD
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State | PA
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Zip | 19096-2515
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Country | US
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Telephone | 617-935-6604
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS017774
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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