Provider Demographics
NPI:1124640982
Name:BERRY, COURTNEY ALEXANDRA (LMSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ALEXANDRA
Last Name:BERRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 DAIRY FARM RD
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1256
Mailing Address - Country:US
Mailing Address - Phone:410-562-4305
Mailing Address - Fax:
Practice Address - Street 1:301 SAINT PAUL ST STE 409
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-659-7041
Practice Address - Fax:410-659-7081
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker