Provider Demographics
NPI:1871789248
Name:DEPREY, COURTNEY A (MHRT-CSP & CADC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:A
Last Name:DEPREY
Suffix:
Gender:F
Credentials:MHRT-CSP & CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 FOX ST
Mailing Address - Street 2:
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1352
Mailing Address - Country:US
Mailing Address - Phone:207-728-6341
Mailing Address - Fax:207-728-7762
Practice Address - Street 1:88 FOX ST
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1352
Practice Address - Country:US
Practice Address - Phone:207-728-6341
Practice Address - Fax:207-728-7762
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME101YM0800X
MECAC4047101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1871789248Medicaid