Provider Demographics
NPI:1922683721
Name:COASTAL GREEN HEALING, PLLC
Entity Type:Organization
Organization Name:COASTAL GREEN HEALING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:KELLY GILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, PMHNP-BC
Authorized Official - Phone:203-641-2530
Mailing Address - Street 1:1204 MAIN ST # 925
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3787
Mailing Address - Country:US
Mailing Address - Phone:203-444-3076
Mailing Address - Fax:203-904-2446
Practice Address - Street 1:30 OLD KINGS HIGHWAY SOUTH
Practice Address - Street 2:1ST FLOOR STE 202
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4551
Practice Address - Country:US
Practice Address - Phone:877-692-6772
Practice Address - Fax:204-904-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT312631OtherATN