Provider Demographics
NPI:1902269814
Name:COURTNEY BIANCHI, LCSW-C, LLC
Entity type:Organization
Organization Name:COURTNEY BIANCHI, LCSW-C, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-354-8630
Mailing Address - Street 1:1190 WINTERSON RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2209
Mailing Address - Country:US
Mailing Address - Phone:443-790-0149
Mailing Address - Fax:
Practice Address - Street 1:1190 WINTERSON RD
Practice Address - Street 2:SUITE 160
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2209
Practice Address - Country:US
Practice Address - Phone:443-354-8630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12568305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service