Healthcare Provider Details

I. General information

NPI: 1114906567
Provider Name (Legal Business Name): ELLEN COUGHLIN COLLINS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 RT 57 WEST
WASHINGTON NJ
07882
US

IV. Provider business mailing address

285 FAIRVIEW AVE
LONG VALLEY NJ
07853
US

V. Phone/Fax

Practice location:
  • Phone: 908-689-1000
  • Fax: 908-689-4529
Mailing address:
  • Phone: 908-876-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC00200700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: