Provider Demographics
NPI:1689412199
Name:FLINT, COURTNEY (LSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:FLINT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 TAYLOR PL APT 422
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2077
Mailing Address - Country:US
Mailing Address - Phone:973-640-2227
Mailing Address - Fax:
Practice Address - Street 1:535 MORRIS AVE STE 3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1025
Practice Address - Country:US
Practice Address - Phone:973-910-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06553500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker