Provider Demographics
NPI:1043846645
Name:REED, KOURTNEY (LMSW)
Entity type:Individual
Prefix:MS
First Name:KOURTNEY
Middle Name:
Last Name:REED
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 1:63 HAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1756
Mailing Address - Country:US
Mailing Address - Phone:585-362-0991
Mailing Address - Fax:
Practice Address - Street 1:63 HAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1756
Practice Address - Country:US
Practice Address - Phone:585-362-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105533-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker