Provider Demographics
NPI:1104917681
Name:COFFEY, WILLAIM (LCSW)
Entity type:Individual
Prefix:MR
First Name:WILLAIM
Middle Name:
Last Name:COFFEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 18TH ST APT 1716
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5934
Mailing Address - Country:US
Mailing Address - Phone:609-706-3369
Mailing Address - Fax:
Practice Address - Street 1:1760 MARKET ST
Practice Address - Street 2:SUITE 700
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4134
Practice Address - Country:US
Practice Address - Phone:215-575-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW 0143711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA644649Medicare ID - Type Unspecified