Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY20173 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY20173 | CA |
Y | 103G00000X | Clinical Psychologist | PSY20173 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY20173 | CA |
NPI | 1326187907 |
---|---|
Provider Name | Dr. John B. Coyne |
First Address | San Francisco, CA 94115-2114 |
Second Address | San Francisco, CA 94115-2114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 11/02/2022 |