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General NPI Number Information
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NPI Number | 1689682346
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Entity Type | Individual
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Provider Name | EDWARD AUGUSTUS COATES LCSW, ED.D
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 6313 CLARK LAKE DRIVE
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City | TRINITY
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State | FL
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Zip | 34655-6014
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Country | US
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Telephone | 727-645-6604
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Fax |
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Provider Business Mailing Address
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Address Line | 6313 CLARK LAKE DR
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City | TRINITY
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State | FL
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Zip | 34655
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Country | US
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Telephone | 727-645-6604
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Fax | 401-277-3366
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW01446
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW6688
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License Number State | FL
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