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NPI Code Detail

MEDICARE: DR. MARY LYNNE COURTNEY PH.D.

MEDICARE: DR. MARY LYNNE COURTNEY PH.D.
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
1103TC2200XClinical Child & Adolescent Psychologist2710NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386620714
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY LYNNE COURTNEY PH.D.
Provider Business Mailing Address
First Line : PO BOX 162
Second Line :
City : CARY
State : NC
Zip : 27512-0162
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7404 CHAPEL HILL RD
Second Line :
City : RALEIGH
State : NC
Zip : 27607-5043
Country : US
Telephone Number : 919-415-0050
Fax Number : 919-467-0979
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2005
Last Update Date : 07/08/2007

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