Provider Demographics
NPI:1649692559
Name:COYLE, TAMARA ZEIGER
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ZEIGER
Last Name:COYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:STANARDSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22973-3705
Mailing Address - Country:US
Mailing Address - Phone:203-916-2177
Mailing Address - Fax:
Practice Address - Street 1:148 SUNSET DR
Practice Address - Street 2:
Practice Address - City:STANARDSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22973-3705
Practice Address - Country:US
Practice Address - Phone:203-916-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-11
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CT0059201041C0700X
VA09040109091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker