Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 1041C0700X | Clinical Social Worker | SW15463 | FL |
NPI | 1003252529 |
---|---|
Provider Name | Nichole White Coyne |
First Address | Saint Petersburg, FL 33702-4305 |
Second Address | Hyannis, MA 02601-2251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2013 |
Last Update Date | 02/12/2021 |