Provider Demographics
NPI:1144309139
Name:COGGSHALL, VALLY (MSW)
Entity type:Individual
Prefix:MS
First Name:VALLY
Middle Name:
Last Name:COGGSHALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WOODLAND STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3545
Mailing Address - Country:US
Mailing Address - Phone:203-776-8663
Mailing Address - Fax:023-865-2043
Practice Address - Street 1:400 PROSPECT STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2181
Practice Address - Country:US
Practice Address - Phone:203-776-8663
Practice Address - Fax:203-865-2043
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0012161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT197627OtherMHN
CT134553OtherVALUE OPTIONS
CT140001216CT01OtherANTHEM BLUE CROSS