Provider Demographics
NPI:1194047738
Name:COFFMAN, JONATHAN RYAN (CTTS-M)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:RYAN
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:CTTS-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 PLANTATION ST
Mailing Address - Street 2:UMASS MEMORIAL MEDICAL CENTER, PSYCHIATRY
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2323
Mailing Address - Country:US
Mailing Address - Phone:508-856-2537
Mailing Address - Fax:508-856-5320
Practice Address - Street 1:361 PLANTATION ST
Practice Address - Street 2:UMASS MEMORIAL MEDICAL CENTER, PSYCHIATRY
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2323
Practice Address - Country:US
Practice Address - Phone:508-856-2537
Practice Address - Fax:508-856-5320
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA196OtherCTTS-M