Provider Demographics
NPI:1043928369
Name:COASTAL PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:COASTAL PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:339-499-8753
Mailing Address - Street 1:32 HAMMOND AVE
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1928
Mailing Address - Country:US
Mailing Address - Phone:339-499-8753
Mailing Address - Fax:
Practice Address - Street 1:32 HAMMOND AVE
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1928
Practice Address - Country:US
Practice Address - Phone:339-499-8753
Practice Address - Fax:781-803-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty