Provider Demographics
NPI:1689682346
Name:COATES, EDWARD AUGUSTUS (LCSW, EDD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:AUGUSTUS
Last Name:COATES
Suffix:
Gender:M
Credentials:LCSW, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6313 CLARK LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655
Mailing Address - Country:US
Mailing Address - Phone:727-645-6604
Mailing Address - Fax:401-277-3366
Practice Address - Street 1:6313 CLARK LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-6014
Practice Address - Country:US
Practice Address - Phone:727-645-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW014461041C0700X
FLSW66881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI050258858OtherPACIFICARE-GROUP
RI31157-3OtherBLUE SHIELD
RI1021740OtherNHP/BEACON GROUP
RI12397075OtherMULTIPLAN
RI413245OtherBLUE CHIP
RI62-35076OtherUNITED BEHAVIORAL HEALTH
RI8274442000OtherMAGELLAN
RIEC59037Medicaid
RI526273OtherVALUE OPTIONS
FLU2092AMedicare PIN
RI050258858OtherPACIFICARE-GROUP
RI8274442000OtherMAGELLAN
RI12397075OtherMULTIPLAN