1053463026 NPI number — MRS. ELEANOR D COFFEY LICSW

Table of content: MRS. ELEANOR D COFFEY LICSW (NPI 1053463026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053463026 NPI number — MRS. ELEANOR D COFFEY LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COFFEY
Provider First Name:
ELEANOR
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053463026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 678
Provider Second Line Business Mailing Address:
37 SOUTH MAIN ST
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-643-1260
Provider Business Mailing Address Fax Number:
603-643-1260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 SOUTH MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-643-1260
Provider Business Practice Location Address Fax Number:
603-643-1260
Provider Enumeration Date:
01/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  13LICSW , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14Y010668NH01 . This is a "ANTHEM BL CROS BL SHIEL" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 7482982 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80001299 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".