Provider Demographics
NPI:1346457892
Name:COKER, BEVERLY ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ELAINE
Last Name:COKER
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 1:880 ASYLUM AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1902
Mailing Address - Country:US
Mailing Address - Phone:860-244-2181
Mailing Address - Fax:860-548-1608
Practice Address - Street 1:880 ASYLUM AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1902
Practice Address - Country:US
Practice Address - Phone:860-244-2181
Practice Address - Fax:860-548-1608
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0013011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical