MEDICARE: DR. PEARL AILSA COAKLEY PSY.D.

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	103TC0700X	Clinical Psychologist	PSY1000044	DC
2	103TC0700X	Clinical Psychologist	O3437	MD
3	103TC0700X	Clinical Psychologist	03437	MD
4	103G00000X	Clinical Neuropsychologist
5	103TC0700X	Clinical Psychologist	0810000357	VA

General Provider Information

NPI Number	:	1427374404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEARL AILSA COAKLEY PSY.D.

Provider Business Mailing Address
First Line	:	12530 FAIRWOOD PKWY STE 102231
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-6356
Country	:	US
Telephone Number	:	301-399-9119
Fax Number	:

Provider Business Practice Location Address
First Line	:	16701 MELFORD BLVD STE 400
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20715-4411
Country	:	US
Telephone Number	:	301-399-9119
Fax Number	:

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	06/01/2025

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