Active NPI
Jonathan Webster Coffin, LICSW, MACP, LADC
- Addiction (Substance Use Disorder) Counselor
- Burlington, VT
National Provider Identifier
1306922612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 000046
- Practice address
- 300 Flynn Ave
Burlington, VT 05401-5301 - Phone
- (802) 488-6100
- Fax
- (802) 488-6901
- NPI assigned
- Oct 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 000046 | VT | Primary |
| Psychologist | 103T00000X | 047-0000159 | VT | |
| Clinical Social Worker | 1041C0700X | 089-0000192 | VT |
Addresses
Primary practice location
300 Flynn Ave
Burlington, VT 05401-5301
Mailing address
208 Flynn Ave
3-J
Burlington, VT 05401-5429
Phone (802) 658-0400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007277 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000046 | VT | MD | Addiction (Substance Use Disorder) Counselor |
| 047-0000159 | VT | MD | Psychologist |
| 089-0000192 | VT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244764800000",
"number": "1306922612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 FLYNN AVE",
"address_2": "3-J",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054015429",
"telephone_number": "802-658-0400",
"fax_number": "802-660-3665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 FLYNN AVE",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054015301",
"telephone_number": "802-488-6100",
"fax_number": "802-488-6901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COFFIN",
"first_name": "JONATHAN",
"middle_name": "WEBSTER",
"credential": "LICSW, MACP, LADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-29",
"last_updated": "2009-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "VT",
"license": "000046",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "VT",
"license": "047-0000159",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VT",
"license": "089-0000192",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007277",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.