Healthcare Provider Details

I. General information

NPI: 1932272309
Provider Name (Legal Business Name): CHRISTINE COOLIDGE RN CS PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 W MONTAUK HWY D 1
HAMPTON BAYS NY
11946
US

IV. Provider business mailing address

18 DUCKWOOD LA
HAMPTON BAYS NY
11946
US

V. Phone/Fax

Practice location:
  • Phone: 631-728-2000
  • Fax:
Mailing address:
  • Phone: 631-728-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number2428621
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0148401
License Number StateNY

VIII. Authorized Official

Name: CHRISTINE COOLIDGE
Title or Position: PRESIDENT
Credential: RN CS PHD
Phone: 631-728-2000