Provider Demographics
NPI:1164579728
Name:COGGINS, ALISSA K (PSYD)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:K
Last Name:COGGINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 HARVARD ST
Mailing Address - Street 2:L6
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2040
Mailing Address - Country:US
Mailing Address - Phone:617-909-4287
Mailing Address - Fax:
Practice Address - Street 1:1 AUTUMN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5393
Practice Address - Country:US
Practice Address - Phone:617-355-7573
Practice Address - Fax:617-730-0271
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7967103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent