MEDICARE: CHAD COFFIN MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MHC01500	RI

General Provider Information

NPI Number	:	1053092734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD COFFIN MA

Provider Business Mailing Address
First Line	:	23 NORTH ROAD SUITE A-28 IN BUILDING A
Second Line	:
City	:	SOUTH KINGSTOWN
State	:	SD
Zip	:	02879-2334
Country	:	US
Telephone Number	:	401-206-0493
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 NORTH RD STE A28
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-8108
Country	:	US
Telephone Number	:	401-206-0493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	08/28/2023

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Directions to “ CHAD COFFIN MA” Practice Location

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