MEDICARE: JAMES COURTNEY

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1659665347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES COURTNEY

Provider Business Mailing Address
First Line	:	102 LOVELL ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01603-2517
Country	:	US
Telephone Number	:	508-410-2152
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 ELM ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-2300
Country	:	US
Telephone Number	:	508-808-2211
Fax Number	:

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

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	05/31/2011

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Directions to “ JAMES COURTNEY ” Practice Location

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