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General NPI Number Information
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NPI Number | 1891286399
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Entity Type | Individual
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Provider Name | MARIE COMA MED
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Gender | Female
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 4229 BARDSTOWN RD STE 126
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City | LOUISVILLE
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State | KY
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Zip | 40218-3284
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Country | US
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Telephone | 502-416-1416
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Fax |
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Provider Business Mailing Address
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Address Line | 307 MCCREADY AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-2751
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Country | US
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Telephone | 412-848-2470
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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