Provider Demographics
NPI:1609644343
Name:COASTAL MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:COASTAL MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-219-7424
Mailing Address - Street 1:25 POMPTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2938
Mailing Address - Country:US
Mailing Address - Phone:302-219-7424
Mailing Address - Fax:281-836-5486
Practice Address - Street 1:25 POMPTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2938
Practice Address - Country:US
Practice Address - Phone:302-219-7424
Practice Address - Fax:281-836-5486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty