Healthcare Provider Details

I. General information

NPI: 1679247605
Provider Name (Legal Business Name): NATHANIEL REX COFFEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD MEZZANINE
PASADENA CA
91101-2039
US

IV. Provider business mailing address

595 E COLORADO BLVD MEZZANINE
PASADENA CA
91101-2039
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-4045
  • Fax: 626-470-9718
Mailing address:
  • Phone: 626-765-4045
  • Fax: 626-470-9718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number102349
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: