Provider Demographics
NPI:1962270736
Name:HENRY, COURTNEY IRENE (MSW, PPSC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:IRENE
Last Name:HENRY
Suffix:
Gender:F
Credentials:MSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 KAISER DR APT 437
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-7529
Mailing Address - Country:US
Mailing Address - Phone:805-450-9961
Mailing Address - Fax:
Practice Address - Street 1:1080 MANGO AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1728
Practice Address - Country:US
Practice Address - Phone:408-522-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1191691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical