Provider Demographics
NPI:1396759874
Name:COUGHLIN, KATHLEEN ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1450 N US HIGHWAY 1 SUITE 500
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:610-248-0059
Mailing Address - Fax:386-492-3590
Practice Address - Street 1:1450 N US 1 SUITE 500
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6311
Practice Address - Country:US
Practice Address - Phone:386-449-8600
Practice Address - Fax:386-492-3590
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PACW0161611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical