| NPI | 1548573645 |
|---|---|
| Former Name | JENNIFER LYNN COUGHLIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 022176) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2010-07-17 |
| Last Update Date | 2019-07-08 |