Provider Demographics
NPI:1154552503
Name:DAVENPORT, COURTNEY BROOKE (MSW)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:BROOKE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:COURTNEY
Other - Middle Name:BROOKE
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:950 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7840
Mailing Address - Country:US
Mailing Address - Phone:941-330-5348
Mailing Address - Fax:
Practice Address - Street 1:950 S TAMIAMI TRL
Practice Address - Street 2:SUITE 202
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7840
Practice Address - Country:US
Practice Address - Phone:941-330-5348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 45821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical