Healthcare Provider Details

I. General information

NPI: 1720563562
Provider Name (Legal Business Name): ALYSSA COAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 FIDDLER AVE.
MERRITT ISLAND FL
32952-3295
US

IV. Provider business mailing address

1315 FIDDLER AVE
MERRITT ISLAND FL
32952-5736
US

V. Phone/Fax

Practice location:
  • Phone: 719-373-7777
  • Fax:
Mailing address:
  • Phone: 719-373-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017212
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3571645
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130058
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: