MEDICARE: ALYSSA COAN MSW

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
1	106S00000X	Behavior Technician
2	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	805-043-931	OTHER	FL	FARS
2	802-049-457	OTHER	FL	CFARS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720563562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA COAN MSW

Provider Business Mailing Address
First Line	:	1315 FIDDLER AVE
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-5736
Country	:	US
Telephone Number	:	719-373-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 FIDDLER AVE.
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-3295
Country	:	US
Telephone Number	:	719-373-7777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	09/27/2018

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Directions to “ ALYSSA COAN MSW” Practice Location

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