Provider Demographics
NPI:1619057874
Name:COUGHLIN, MARIBETH (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIBETH
Middle Name:
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 LIBBEY INDUSTRIAL PKWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3101
Mailing Address - Country:US
Mailing Address - Phone:781-682-1060
Mailing Address - Fax:781-682-1061
Practice Address - Street 1:169 LIBBEY INDUSTRIAL PKWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3101
Practice Address - Country:US
Practice Address - Phone:781-682-1060
Practice Address - Fax:781-682-1061
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10245511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA081218OtherVALUE OPTIONS PROVIDER NU
MAP07016OtherBCBS PROVIDER NUMBER
MD6200034OtherEVERCARE PROVIDER NUMBER
MD6200034OtherEVERCARE PROVIDER NUMBER