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NPI Code Detail

MEDICARE: COASTAL PSYCHOLOGY AND EDUCATION ASSOCIATES, LLC

MEDICARE: COASTAL PSYCHOLOGY AND EDUCATION ASSOCIATES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1KEF1OTHERMDBCBS OF MD
27552438OTHERMDAETNA
3G800OTHERMDBCBS NATIONAL

General Provider Information

NPI Number : 1659380087
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL PSYCHOLOGY AND EDUCATION ASSOCIATES, LLC
Provider Business Mailing Address
First Line : 38924 BLUE INDIGO RD
Second Line :
City : SELBYVILLE
State : DE
Zip : 19975-3795
Country : US
Telephone Number : 410-208-4784
Fax Number : 855-201-7322
Provider Business Practice Location Address
First Line : 33195 LIGHTHOUSE RD
Second Line : UNIT 11
City : SELBYVILLE
State : DE
Zip : 19975-4071
Country : US
Telephone Number : 410-208-4784
Fax Number : 855-201-7322
Authorized Official
Title or Position : OWNER
Name : DONNA IGNELZI-FERRARO
Credential : PHD
Telephone Number : 410-208-4784
Provider Enumeration Date : 08/05/2006
Last Update Date : 10/10/2013

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