Provider Demographics
NPI:1235256314
Name:NELSON, COURTNEY (LICSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FORGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-1012
Mailing Address - Country:US
Mailing Address - Phone:401-391-9353
Mailing Address - Fax:
Practice Address - Street 1:350 FORGE RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-1012
Practice Address - Country:US
Practice Address - Phone:401-391-9353
Practice Address - Fax:508-557-0131
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW019741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical