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General NPI Number Information
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NPI Number | 1518046192
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Entity Type | Individual
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Provider Name | JOHN B. COYLE LMFT. CASAC
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Gender | Male
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 7509 N. BROADWAY (RT. 9)
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City | RED HOOK
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State | NY
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Zip | 12571
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Country | US
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Telephone | 845-206-8815
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Fax | 845-758-0608
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Provider Business Mailing Address
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Address Line | 7509 N. BROADWAY (RT. 9)
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City | RED HOOK
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State | NY
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Zip | 12571
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Country | US
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Telephone | 845-206-8815
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Fax | 845-758-0608
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CREDENTIAL # 3356
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000483
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000483-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3356
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License Number State | NY
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