Provider Demographics
NPI:1558576983
Name:KATHLEEN COUGHLIN
Entity Type:Organization
Organization Name:KATHLEEN COUGHLIN
Other - Org Name:KATHLEEN COUGHLIN, LSW & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:610-861-8779
Mailing Address - Street 1:308 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6311
Mailing Address - Country:US
Mailing Address - Phone:610-861-8779
Mailing Address - Fax:610-861-4677
Practice Address - Street 1:308 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6311
Practice Address - Country:US
Practice Address - Phone:610-861-8779
Practice Address - Fax:610-861-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW013427L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014056050001Medicaid