Individual
MR. ROBERT JOSEPH COYNE SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW, LADAC
Contact information
Practice address
127 EASTGATE DR, STE 212 H, LOS ALAMOS, NM 87544-3300
(505) 661-9700
(505) 663-0100
Mailing address
2164 43RD ST, STE C, LOS ALAMOS, NM 87544-1745
(505) 661-7555
(505) 663-0100
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
4758
NM
1041C0700X
Clinical Social Worker
Primary
X-06325
NM
Other
Enumeration date
02/18/2009
Last updated
02/18/2009
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