Provider Demographics
NPI:1255434148
Name:COUGHLIN, ROBYN E (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:E
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ROBYN COUGHLIN
Mailing Address - Street 1:8690 AERO DR STE 115-219
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1886
Mailing Address - Country:US
Mailing Address - Phone:619-997-5310
Mailing Address - Fax:
Practice Address - Street 1:1400 112TH AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6901
Practice Address - Country:US
Practice Address - Phone:619-997-5310
Practice Address - Fax:954-715-1741
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X
WALW607254691041C0700X
CA241371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health