Provider Demographics
NPI:1932266442
Name:COENTRO, YOLANDA NICOLE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:NICOLE
Last Name:COENTRO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-4626
Mailing Address - Country:US
Mailing Address - Phone:617-797-6837
Mailing Address - Fax:401-245-8148
Practice Address - Street 1:161 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4885
Practice Address - Country:US
Practice Address - Phone:617-264-5311
Practice Address - Fax:617-232-7925
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1133801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical