Individual
COURTNEY DANIELLE KISAMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LGSW
Contact information
Practice address
120 PROFESSIONAL PL STE 101, BRIDGEPORT, WV 26330-4599
(304) 513-3495
Mailing address
101 PEMBROKE CT, GREENSBURG, PA 15601-6404
(724) 396-1510
(724) 972-4627
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
BP00946369
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699484014
—
WV
Enumeration date
11/15/2022
Last updated
04/15/2026
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