Provider Demographics
NPI:1669561577
Name:COINER, MARYROSE C (PHD)
Entity type:Individual
Prefix:DR
First Name:MARYROSE
Middle Name:C
Last Name:COINER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2876
Mailing Address - Country:US
Mailing Address - Phone:508-620-9948
Mailing Address - Fax:
Practice Address - Street 1:600 WORCESTER RD
Practice Address - Street 2:STE 501
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5303
Practice Address - Country:US
Practice Address - Phone:508-620-9948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW0295001OtherMEDICARE PTAN