MEDICARE: COURTNEY MARIE CONTRERAS

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	C013099	NY
2	1041C0700X	Clinical Social Worker	087888	NY
3	1041C0700X	Clinical Social Worker	C013099	NC

General Provider Information

NPI Number	:	1497321145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY MARIE CONTRERAS

Provider Business Mailing Address
First Line	:	3857 CRABTREE AVE
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2994
Country	:	US
Telephone Number	:	919-812-5850
Fax Number	:

Provider Business Practice Location Address
First Line	:	3857 CRABTREE AVE
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2994
Country	:	US
Telephone Number	:	919-812-5850
Fax Number	:

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

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	04/11/2022

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Directions to “ COURTNEY MARIE CONTRERAS ” Practice Location

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