Doctor Name: | MR. KEVIN M COLEMAN |
NPI Number: | 1275667982 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW-R |
License Number: | 070653-1 |
Business Practice Address: | 20 Montauk Hwy Blue Point, NY - 117151139 |
Business Phone Number: | 6313638623 |
Business Fax Number: | 6313630027 |
Mailing Address: | 1960 Bayberry Ave, Slip #2 MERRICK |
State: | NY |
Postal Code: | 115665561 |
Phone Number: | 5166236464 |
Fax Number: | |
NPI Enumeration Date: | 03/15/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 070653-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |