Jacquelyn Coughlin, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW 10963 Issued in FL

Practice address

10901 Carnelian LN
Riverview, FL 33578-3915

Phone

(813) 967-5616

NPI assigned

Nov 18, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brandon Mental HealthGroup PAC ID 8527136977, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brandon Mental Health

  • Community/Behavioral Health Agency
  • Brandon, FL
  • NPI 1649421389
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384732800000",
    "number": "1396175980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10901 CARNELIAN LN",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335783915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10901 CARNELIAN LN",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335783915",
            "telephone_number": "813-967-5616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUGHLIN",
        "first_name": "JACQUELYN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-18",
        "last_updated": "2013-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW 10963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corinne Elissa Correa
• Dejuanna Oubre Corson, RN, APRN
• Danny Lee Cosby, CAP/SAP
• Lia Costa Moreno, BEHAVIOR TECHNICIAN
• Kaela Cotton
• Counseling Associates of Tampa Bay, LLC
• Counseling Offices of Riverview
• Dymond Covington
• Tevin Ahmad Covington, PHARMD.
• Desarae Cox

• Clinical Social Worker in Riverview, FL
• Providers in Riverview, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.