Provider Demographics
NPI:1093126963
Name:COUGHLIN, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MYSTIC AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4632
Mailing Address - Country:US
Mailing Address - Phone:781-396-1199
Mailing Address - Fax:781-396-1439
Practice Address - Street 1:90 NEW STATE HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-5460
Practice Address - Country:US
Practice Address - Phone:508-880-6868
Practice Address - Fax:508-880-6848
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker