Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 2814 | MA |
N | 103TC0700X | Clinical Psychologist | 2814 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2814 | MA |
N | 103G00000X | Clinical Psychologist | 2814 | MA |
N | 103TC0700X | Clinical Psychologist | 2814 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2814 | MA |
N | 103TF0000X | Family Psychologist | 2814 | MA |
N | 103TH0100X | Health Service | 2814 | MA |
N | 103TM1800X | Intellectual & Developmental Disabilities | 2814 | MA |
NPI | 1043360936 |
---|---|
Provider Name | Dr. Hugh Coffman |
First Address | Brookline, MA 02446-5439 |
Second Address | Lexington, MA 02420-4640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W02968 | BCBSMA PROVIDER NUMBER (01) | MA |