Provider Demographics
NPI:1003946765
Name:COELHO, PHYLLIS ANTOINETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:ANTOINETTE
Last Name:COELHO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6120
Mailing Address - Country:US
Mailing Address - Phone:207-338-0254
Mailing Address - Fax:
Practice Address - Street 1:124 CEDAR ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6120
Practice Address - Country:US
Practice Address - Phone:207-338-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR024223-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN30801Medicare ID - Type UnspecifiedPROVIDER NUMBER