Provider Demographics
NPI:1164636437
Name:COE, THERESA A (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:A
Last Name:COE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 4TH PLACE
Mailing Address - Street 2:C-2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4525
Mailing Address - Country:US
Mailing Address - Phone:347-267-5999
Mailing Address - Fax:718-408-3276
Practice Address - Street 1:164 20TH STREET
Practice Address - Street 2:SUITE 3B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231
Practice Address - Country:US
Practice Address - Phone:718-875-5051
Practice Address - Fax:718-408-3276
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR045948-11041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical