Provider Demographics
NPI:1619202298
Name:COOGAN, PATRICE MARIE (M A)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:MARIE
Last Name:COOGAN
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-4801
Mailing Address - Country:US
Mailing Address - Phone:401-625-1245
Mailing Address - Fax:
Practice Address - Street 1:101 ROCK ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3133
Practice Address - Country:US
Practice Address - Phone:508-678-7542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6117101YM0800X
MA303409104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker