Provider Demographics
NPI:1528445871
Name:COUGHLIN, ASHLEY FARRELL (MD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:FARRELL
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:FARRELL
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:MIDDLESEX HOSPITAL MENTAL HEALTH SERVICES
Mailing Address - Street 2:28 CRESCENT STREET
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-358-3923
Mailing Address - Fax:860-358-8281
Practice Address - Street 1:1250 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4405
Practice Address - Country:US
Practice Address - Phone:860-358-3923
Practice Address - Fax:860-358-8281
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT0601642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program