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General NPI Number Information
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NPI Number | 1609644343
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Entity Type | Organization
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Legal Business Name | COASTAL MENTAL HEALTH LLC
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 25 POMPTON AVE STE 101
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City | VERONA
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State | NJ
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Zip | 07044-2938
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Country | US
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Telephone | 302-219-7424
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Fax | 281-836-5486
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Provider Business Mailing Address
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Address Line | 25 POMPTON AVE STE 101
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City | VERONA
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State | NJ
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Zip | 07044-2938
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Country | US
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Telephone | 302-219-7424
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Fax | 281-836-5486
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | LUCIANA THOMPSON
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Credential |
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Telephone | 302-219-7424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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