Provider Demographics
NPI:1659380087
Name:COASTAL PSYCHOLOGY AND EDUCATION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:COASTAL PSYCHOLOGY AND EDUCATION ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:IGNELZI-FERRARO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-208-4784
Mailing Address - Street 1:38924 BLUE INDIGO RD
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-3795
Mailing Address - Country:US
Mailing Address - Phone:410-208-4784
Mailing Address - Fax:855-201-7322
Practice Address - Street 1:33195 LIGHTHOUSE RD
Practice Address - Street 2:UNIT 11
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-4071
Practice Address - Country:US
Practice Address - Phone:410-208-4784
Practice Address - Fax:855-201-7322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKEF1OtherBCBS OF MD
MD7552438OtherAETNA
MDG800OtherBCBS NATIONAL
MD133997-ZA4XMedicare PIN