Basic Information
| Provider Information | |||||||||
| NPI: | 1265084370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COYA | ||||||||
| FirstName: | BRIAN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 GOLD ST APT C | ||||||||
| Address2: | |||||||||
| City: | NORTH ARLINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070315212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5515803045 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 VALLEY HEALTH PLZ | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076523607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012658200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2019 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SC05698500 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.