Healthcare Provider Details

I. General information

NPI: 1982185096
Provider Name (Legal Business Name): ROBYN COONS LICSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 PATTON RD
AYER MA
01434-3802
US

IV. Provider business mailing address

60 SHRINE AVE
WEST BOYLSTON MA
01583-1930
US

V. Phone/Fax

Practice location:
  • Phone: 978-796-1084
  • Fax: 978-796-1079
Mailing address:
  • Phone: 508-887-6264
  • Fax: 978-796-1079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1025016
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: