Healthcare Provider Details

I. General information

NPI: 1558072876
Provider Name (Legal Business Name): BRITTANY COYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/07/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5530 COLLEGE AVE STE 240
OAKLAND CA
94618
US

IV. Provider business mailing address

360 LYNNFIELD ST
LYNN MA
01904-1411
US

V. Phone/Fax

Practice location:
  • Phone: 888-362-3970
  • Fax:
Mailing address:
  • Phone: 781-420-4697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4264
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: