Provider Demographics
NPI:1205389699
Name:COYNE, ERICA (LCSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:COYNE
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 1:5445 LANARK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-8694
Mailing Address - Country:US
Mailing Address - Phone:484-526-7035
Mailing Address - Fax:
Practice Address - Street 1:5445 LANARK RD STE 200
Practice Address - Street 2:
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-8694
Practice Address - Country:US
Practice Address - Phone:607-744-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133364104100000X
PACW0202231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker