Basic Information
| Provider Information | |||||||||
| NPI: | 1346307022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COATES | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, MBA, LMHC, LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 ERDMAN WAY | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014531804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784668390 | ||||||||
| FaxNumber: | 9785373496 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 ERDMAN WAY | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014531804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784668390 | ||||||||
| FaxNumber: | 9785373496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 09/10/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 3789 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | E-0003844 | OH | N | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.