Basic Information
| Provider Information | |||||||||
| NPI: | 1336789825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COYNE | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | OWEN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2191 | ||||||||
| Address2: | |||||||||
| City: | DUXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023312191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038099426 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 39A INDUSTRIAL PARK RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023604868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088301444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2020 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.