Provider Demographics
NPI:1528507837
Name:COFFIN, ANDREW (BHP, DSP, CRMA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:COFFIN
Suffix:
Gender:M
Credentials:BHP, DSP, CRMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 NARRAGANSETT ST.
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038
Mailing Address - Country:US
Mailing Address - Phone:207-272-2723
Mailing Address - Fax:
Practice Address - Street 1:95 NARRAGANSETT ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1411
Practice Address - Country:US
Practice Address - Phone:207-272-2723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME815224290103K00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst