Provider Demographics
NPI:1538538764
Name:CORAL, MEGAN P (MS, LMFT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:P
Last Name:CORAL
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 UNION ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4498
Mailing Address - Country:US
Mailing Address - Phone:201-652-5114
Mailing Address - Fax:201-652-6253
Practice Address - Street 1:174 UNION ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4498
Practice Address - Country:US
Practice Address - Phone:201-652-5114
Practice Address - Fax:201-652-6253
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00178600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist