Provider Demographics
NPI:1588363246
Name:GEORGE, COURTNEY MARISSA
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARISSA
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CLINTWOOD CT # G
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3504
Mailing Address - Country:US
Mailing Address - Phone:585-727-6388
Mailing Address - Fax:
Practice Address - Street 1:175 N WINTON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1936
Practice Address - Country:US
Practice Address - Phone:585-410-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118520104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker