Provider Demographics
NPI:1104308923
Name:SANDRA A COAKLEY PSYCHOTHERAPIST LLC
Entity type:Organization
Organization Name:SANDRA A COAKLEY PSYCHOTHERAPIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-886-7836
Mailing Address - Street 1:128 CARRIAGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2006
Mailing Address - Country:US
Mailing Address - Phone:203-886-7836
Mailing Address - Fax:
Practice Address - Street 1:128 CARRIAGE HILL DR
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2006
Practice Address - Country:US
Practice Address - Phone:203-886-7836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty