Provider Demographics
NPI:1497848907
Name:COYLE, JUDITH ANN (LMHC,LMFT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:COYLE
Suffix:
Gender:F
Credentials:LMHC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 UNION STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2853
Mailing Address - Country:US
Mailing Address - Phone:781-337-8409
Mailing Address - Fax:508-895-9990
Practice Address - Street 1:172 UNION STREET
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2853
Practice Address - Country:US
Practice Address - Phone:781-337-8409
Practice Address - Fax:508-895-9990
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1077101YM0800X
MA538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0008OtherBC/BS
MA768530OtherTUFTS