Provider Demographics
NPI:1023471984
Name:FOSTER, COURTNEY (BCABA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:HERMSDORFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9536 PRINCETON SQUARE BLVD S
Mailing Address - Street 2:APT 1512
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0322
Mailing Address - Country:US
Mailing Address - Phone:850-227-5159
Mailing Address - Fax:
Practice Address - Street 1:3525 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7122
Practice Address - Country:US
Practice Address - Phone:850-227-5159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BACB367726106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst