Provider Demographics
NPI:1376015461
Name:COFFIN, CAROLYN (LICSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:COFFIN
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 1:18 ISAAC DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-1512
Mailing Address - Country:US
Mailing Address - Phone:978-318-7073
Mailing Address - Fax:
Practice Address - Street 1:18 ISAAC DAVIS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1512
Practice Address - Country:US
Practice Address - Phone:978-318-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-30
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10247341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical