Provider Demographics
NPI:1962698670
Name:COUGHLIN, NANCY MONAGHAN (LCSW-R, CASAC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:MONAGHAN
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1310
Mailing Address - Country:US
Mailing Address - Phone:585-315-6674
Mailing Address - Fax:585-671-7992
Practice Address - Street 1:240 RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1310
Practice Address - Country:US
Practice Address - Phone:585-315-6674
Practice Address - Fax:585-671-7992
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0706161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical