Individual
FREDERICK COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
495 CONGRESS AVE, NEW HAVEN, CT 06519-1312
(203) 781-4600
(203) 781-4624
Mailing address
1 LONG WHARF DR, NEW HAVEN, CT 06511-5946
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9362
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008064062
COBURN MEDICAID
CT
Enumeration date
02/18/2016
Last updated
06/07/2016
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