Provider Demographics
NPI:1568428464
Name:COATES, CAROLE L (RN LICSW DCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:L
Last Name:COATES
Suffix:
Gender:F
Credentials:RN LICSW DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JEFFERSON BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888
Mailing Address - Country:US
Mailing Address - Phone:401-461-2842
Mailing Address - Fax:401-461-3091
Practice Address - Street 1:90 JEFFERSON BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888
Practice Address - Country:US
Practice Address - Phone:401-461-2842
Practice Address - Fax:401-461-3091
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILSW01480104100000X
MA111331104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICC51134Medicaid
RI232155OtherBLUE CROSS
7518662OtherAETNA
2202927OtherFIRST HEALTH
2213428190002OtherCIGNA
281484OtherMHN
1043060OtherBEACON HEALTH STRATEGIC
281484OtherMHN