Provider Demographics
NPI:1497974505
Name:COYNE, STEPHANIE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:S
Last Name:COYNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 WESTWOOD AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6295
Mailing Address - Country:US
Mailing Address - Phone:201-666-5515
Mailing Address - Fax:201-666-8475
Practice Address - Street 1:106 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2400
Practice Address - Country:US
Practice Address - Phone:201-666-5515
Practice Address - Fax:201-666-8475
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2867103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist