MEDICARE: JANE R COYLE LCSW

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	101YM0800X	Mental Health Counselor	0003315	FL

General Provider Information

NPI Number	:	1831249689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE R COYLE LCSW

Provider Business Mailing Address
First Line	:	1255 37TH ST
Second Line	:	SUITE A
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6550
Country	:	US
Telephone Number	:	772-569-3100
Fax Number	:	772-569-0217

Provider Business Practice Location Address
First Line	:	1255 37TH ST
Second Line	:	SUITE A
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6550
Country	:	US
Telephone Number	:	772-569-3100
Fax Number	:	772-569-0217

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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