Provider Demographics
NPI:1649262569
Name:MCCOURT, BERNADETTE C (PHD)
Entity type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:C
Last Name:MCCOURT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 NIAGARA ST STE 230
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1776
Mailing Address - Country:US
Mailing Address - Phone:716-512-5577
Mailing Address - Fax:716-580-7006
Practice Address - Street 1:1250 NIAGARA ST STE 230
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1776
Practice Address - Country:US
Practice Address - Phone:716-512-5577
Practice Address - Fax:716-580-7006
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY474421475103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty