Provider Demographics
NPI:1962630764
Name:WRIGHT, ESTELL COFFY (MED)
Entity Type:Individual
Prefix:MS
First Name:ESTELL
Middle Name:COFFY
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 RUTHVEN ST # 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-1611
Mailing Address - Country:US
Mailing Address - Phone:857-756-5682
Mailing Address - Fax:
Practice Address - Street 1:54 RUTHVEN ST # 2
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-1611
Practice Address - Country:US
Practice Address - Phone:857-756-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health