1649353939 NPI number — MS. LARA COGLIANO LICSW

Table of content: MS. LARA COGLIANO LICSW (NPI 1649353939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649353939 NPI number — MS. LARA COGLIANO LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COGLIANO
Provider First Name:
LARA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649353939
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 HIGH STREET
Provider Second Line Business Mailing Address:
#2
Provider Business Mailing Address City Name:
CHARLESTOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-241-7760
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
873 TURNPIKE STREET
Provider Second Line Business Practice Location Address:
THE SOMERS TRUST PSYCHOLOGICAL ASSOCIATES
Provider Business Practice Location Address City Name:
NORTH ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-688-8004
Provider Business Practice Location Address Fax Number:
978-686-8554
Provider Enumeration Date:
10/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  12264 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)