Provider Demographics
NPI:1528141744
Name:COYNE, JEANNINE M
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:M
Last Name:COYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PARK CT W
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8232
Mailing Address - Country:US
Mailing Address - Phone:856-596-5399
Mailing Address - Fax:856-983-1398
Practice Address - Street 1:106 PARK CT W
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8232
Practice Address - Country:US
Practice Address - Phone:856-596-5399
Practice Address - Fax:856-983-1398
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000374001041C0700X
PACW0141761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical