Provider Demographics
NPI:1902421845
Name:COBERLY, JAMES BENNER (MA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BENNER
Last Name:COBERLY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:COBERLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1127 POINTE NEWPORT TER APT 203
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-7216
Mailing Address - Country:US
Mailing Address - Phone:616-307-5199
Mailing Address - Fax:
Practice Address - Street 1:7984 FOREST CITY RD STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-2907
Practice Address - Country:US
Practice Address - Phone:813-290-8560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19715101YM0800X
FLMH21422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health