Provider Demographics
NPI:1851796205
Name:DR. PATRICIA COUGHLIN
Entity Type:Organization
Organization Name:DR. PATRICIA COUGHLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-859-3960
Mailing Address - Street 1:48 COLUMBIA ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2746
Mailing Address - Country:US
Mailing Address - Phone:518-859-3960
Mailing Address - Fax:
Practice Address - Street 1:48 COLUMBIA ST STE 2
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-2746
Practice Address - Country:US
Practice Address - Phone:518-859-3960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010001261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010001OtherNY STATE LICENSE