Doctor Name: | MR. RICHARD IRA COLEMAN |
NPI Number: | 1003097981 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 20 Community Ln Liberty, NY - 127542851 |
Business Phone Number: | 8452928770 |
Business Fax Number: | 8452924206 |
Mailing Address: | Po Box 716, LIBERTY |
State: | NY |
Postal Code: | 127540716 |
Phone Number: | 8452928770 |
Fax Number: | 8452924206 |
NPI Enumeration Date: | 11/19/2007 |
NPI Last Update Date: | 11/19/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |