MEDICARE: EVADNE C COACHE 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	1041C0700X	Clinical Social Worker	13730	CT

General Provider Information

NPI Number	:	1942067079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVADNE C COACHE LCSW

Provider Business Mailing Address
First Line	:	32 BYRD RD
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06109-3005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	553 FARMINGTON AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-3026
Country	:	US
Telephone Number	:	860-995-7932
Fax Number	:

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

Provider Enumeration Date	:	03/05/2024
Last Update Date	:	03/05/2024

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Directions to “ EVADNE C COACHE LCSW” Practice Location

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