Individual
COURTNEY ANN FORMICOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., M.PSY
Contact information
Practice address
859 WILLARD ST, QUINCY, MA 02169-7482
(914) 384-0915
Mailing address
1701 16TH ST NW APT 640, WASHINGTON, DC 20009-3155
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/24/2018
Last updated
05/24/2018
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