Provider Demographics
NPI:1619520699
Name:K M COELHOVERA EDS LPC
Entity Type:Organization
Organization Name:K M COELHOVERA EDS LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:COELHO-VERA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:201-362-7036
Mailing Address - Street 1:39 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2717
Mailing Address - Country:US
Mailing Address - Phone:201-362-7036
Mailing Address - Fax:
Practice Address - Street 1:290 CHESTNUT ST STE 206
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-6524
Practice Address - Country:US
Practice Address - Phone:201-362-7036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty