Provider Demographics
NPI:1740628841
Name:COYNE, JOSEPH G (MED, BSL)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:G
Last Name:COYNE
Suffix:
Gender:M
Credentials:MED, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-8423
Mailing Address - Country:US
Mailing Address - Phone:610-329-4793
Mailing Address - Fax:
Practice Address - Street 1:2430 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-8423
Practice Address - Country:US
Practice Address - Phone:610-329-4793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health