Healthcare Provider Details

I. General information

NPI: 1821514688
Provider Name (Legal Business Name): ANNA COUGHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 FARMINGTON AVE STE 301
FARMINGTON CT
06032-1909
US

IV. Provider business mailing address

194 WOODLAND ST
SOUTH GLASTONBURY CT
06073-2716
US

V. Phone/Fax

Practice location:
  • Phone: 860-222-0790
  • Fax:
Mailing address:
  • Phone: 860-944-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number46.008011
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: