=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679737035
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL NEUROBEHAVIORAL CENTER, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2008
-----------------------------------------------------
Last Update Date | 02/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 46 MAIN ST
-----------------------------------------------------
City | YARMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04096-6709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-846-3023
-----------------------------------------------------
Fax | 207-846-3028
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 MAIN ST
-----------------------------------------------------
City | YARMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04096-6709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-846-3023
-----------------------------------------------------
Fax | 207-846-3028
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HOWARD R KESSLER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 207-846-3023
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------