Provider Demographics
NPI:1164673539
Name:COBURN, PETER J (MSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:COBURN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14911 COLDWATER LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2215
Mailing Address - Country:US
Mailing Address - Phone:813-495-2156
Mailing Address - Fax:
Practice Address - Street 1:14911 COLDWATER LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2215
Practice Address - Country:US
Practice Address - Phone:813-495-2156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 1798104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker