MEDICARE: MS. TALITHA COGGINS MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1053699413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TALITHA COGGINS MSW

Provider Business Mailing Address
First Line	:	258 MIDDLE ST
Second Line	:
City	:	BRISTOL
State	:	CT
Zip	:	06010-7492
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	258 MIDDLE ST
Second Line	:
City	:	BRISTOL
State	:	CT
Zip	:	06010-7492
Country	:	US
Telephone Number	:	860-965-3088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2011
Last Update Date	:	08/02/2011

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