Provider Demographics
NPI:1053092734
Name:COFFIN, CHAD (MA)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:COFFIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NORTH ROAD SUITE A-28 IN BUILDING A
Mailing Address - Street 2:
Mailing Address - City:SOUTH KINGSTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:02879-2334
Mailing Address - Country:US
Mailing Address - Phone:401-206-0493
Mailing Address - Fax:
Practice Address - Street 1:23 NORTH RD STE A28
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-8108
Practice Address - Country:US
Practice Address - Phone:401-206-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health