Healthcare Provider Details

I. General information

NPI: 1356254452
Provider Name (Legal Business Name): EMILY DAGUMAN COINCO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY D. COINCO PMHNP-BC

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PMB: 149, 968 BRADLEY STREET
WATERTOWN NY
13601
US

IV. Provider business mailing address

PMB: 149, 968 BRADLEY STREET
WATERTOWN NY
13601
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: --
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408888
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: