Provider Demographics
NPI:1447936638
Name:COASTAL INTEGRATIVE MENTAL HEALTH INC.
Entity type:Organization
Organization Name:COASTAL INTEGRATIVE MENTAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:ALANA
Authorized Official - Last Name:MOLNAR
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:781-474-2840
Mailing Address - Street 1:105 WEBSTER ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1227
Mailing Address - Country:US
Mailing Address - Phone:781-474-2840
Mailing Address - Fax:781-474-2840
Practice Address - Street 1:105 WEBSTER ST STE 5
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1227
Practice Address - Country:US
Practice Address - Phone:781-474-2840
Practice Address - Fax:781-474-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1083253017OtherINDIVIDUAL NPI