Provider Demographics
NPI:1083744817
Name:COYNE, LAUREN JANE (LICSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JANE
Last Name:COYNE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2276
Mailing Address - Country:US
Mailing Address - Phone:617-489-1835
Mailing Address - Fax:
Practice Address - Street 1:5 HALL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2003
Practice Address - Country:US
Practice Address - Phone:617-623-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19258801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACOP20508Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER