Healthcare Provider Details

I. General information

NPI: 1902542491
Provider Name (Legal Business Name): GERALD MARK COATES MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MOULTON AVE
LEBANON NH
03766-1852
US

IV. Provider business mailing address

3 MOULTON AVE
LEBANON NH
03766-1852
US

V. Phone/Fax

Practice location:
  • Phone: 603-667-6148
  • Fax:
Mailing address:
  • Phone: 603-448-3056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number40825
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: