Healthcare Provider Details

I. General information

NPI: 1053706770
Provider Name (Legal Business Name): JENELLE COIT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4269 STATE ROUTE 104
NEW HAVEN NY
13121
US

IV. Provider business mailing address

PO BOX 27
NEW HAVEN NY
13121-0027
US

V. Phone/Fax

Practice location:
  • Phone: 315-746-2453
  • Fax:
Mailing address:
  • Phone: 315-746-2453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number090056
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number091042-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: