Provider Demographics
NPI:1912752023
Name:ROBYN COUGHLIN, LCSW, LLC
Entity Type:Organization
Organization Name:ROBYN COUGHLIN, LCSW, LLC
Other - Org Name:ROBYN COUGHLIN, LCSW GROUP PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COUGHLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBYN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LICSW, BCD
Authorized Official - Phone:619-997-5310
Mailing Address - Street 1:8690 AERO DR # 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:954-715-2741
Practice Address - Street 1:8690 AERO DR # 115-219
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1886
Practice Address - Country:US
Practice Address - Phone:619-997-5310
Practice Address - Fax:954-715-2741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty