Provider Demographics
NPI:1164103818
Name:COUGHLIN CONSULTATION GROUP, P.A.
Entity Type:Organization
Organization Name:COUGHLIN CONSULTATION GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:COUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:609-947-5317
Mailing Address - Street 1:3576 QUAKERBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619
Mailing Address - Country:US
Mailing Address - Phone:609-586-7757
Mailing Address - Fax:
Practice Address - Street 1:3576 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619
Practice Address - Country:US
Practice Address - Phone:609-947-5317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty