Courtney Jermaine Wilson, PHD, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

19793 Issued in FL

Practice address

9346 NW 49TH PL
Sunrise, FL 33351-5261

Phone

(646) 667-3727

NPI assigned

Jun 21, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2015

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1114658176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11200 SW 8TH ST # STREET5",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331992516",
            "telephone_number": "407-917-3009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9346 NW 49TH PL",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333515261",
            "telephone_number": "646-667-3727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "COURTNEY",
        "middle_name": "JERMAINE",
        "name_prefix": "Dr.",
        "credential": "PHD, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-21",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "19793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Varron A Williams, DPT
• Jimmie Elliott Williamson, CRNA
• Diane Willis
• Mark Steven Willner, M.D.
• Edward Wills
• Holly Wilson, M.D.
• Kevin Anthony Wilson, DO
• Timothy R. Wilson, MD
• Tammy K. Windisch, DO
• Thomas Windisch, DO

• Clinical Social Worker in Sunrise, FL
• Providers in Sunrise, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.