Provider Demographics
NPI:1649353939
Name:COGLIANO, LARA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LARA
Middle Name:
Last Name:COGLIANO
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 1:30 HIGH STREET
Mailing Address - Street 2:#2
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129
Mailing Address - Country:US
Mailing Address - Phone:617-241-7760
Mailing Address - Fax:
Practice Address - Street 1:873 TURNPIKE STREET
Practice Address - Street 2:THE SOMERS TRUST PSYCHOLOGICAL ASSOCIATES
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01895
Practice Address - Country:US
Practice Address - Phone:978-688-8004
Practice Address - Fax:978-686-8554
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12264104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACOP23897Medicare PIN
Q57255Medicare UPIN