MEDICARE: COURTNEY PLANK RAULT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	011885	CT
2	1041C0700X	Clinical Social Worker	103814	NY
3	1041C0700X	Clinical Social Worker	092028	NY

General Provider Information

NPI Number	:	1124641360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY PLANK RAULT LCSW

Provider Business Mailing Address
First Line	:	209 BEDFORD BANKSVILLE RD
Second Line	:
City	:	BEDFORD
State	:	NY
Zip	:	10506-1918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 BEDFORD BANKSVILLE RD
Second Line	:
City	:	BEDFORD
State	:	NY
Zip	:	10506-1918
Country	:	US
Telephone Number	:	617-697-9471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	04/04/2023

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