Individual
JONATHAN WEBSTER COFFIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW, MACP, LADC
Contact information
Practice address
300 FLYNN AVE, BURLINGTON, VT 05401-5301
(802) 488-6100
(802) 488-6901
Mailing address
208 FLYNN AVE, 3-J, BURLINGTON, VT 05401-5429
(802) 658-0400
(802) 660-3665
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000046
VT
103T00000X
Psychologist
047-0000159
VT
1041C0700X
Clinical Social Worker
089-0000192
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007277
—
VT
Enumeration date
10/29/2006
Last updated
06/12/2009
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