Individual
MARY COUGHTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
81 LAKE AVE, ROCHESTER, NY 14608-1410
(585) 368-6900
Mailing address
81 LAKE AVE, ROCHESTER, NY 14608-1410
(585) 368-6900
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
012696
NY
Other
Enumeration date
08/14/2008
Last updated
01/16/2017
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