Healthcare Provider Details

I. General information

NPI: 1619202298
Provider Name (Legal Business Name): PATRICE MARIE COOGAN M. A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICE GOODMAN LMHC

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 DRIFTWOOD DR
TIVERTON RI
02878-4801
US

IV. Provider business mailing address

61 DRIFTWOOD DR
TIVERTON RI
02878-4801
US

V. Phone/Fax

Practice location:
  • Phone: 401-625-1245
  • Fax:
Mailing address:
  • Phone: 401-625-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6117
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number303409
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: