Provider Demographics
NPI:1043992803
Name:COLEMAN, CAMERON RYAN SHEEHAN (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:RYAN SHEEHAN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:CAMERON
Other - Middle Name:RYAN
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:491 US ROUTE 1 STE 23
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-7022
Mailing Address - Country:US
Mailing Address - Phone:207-200-1631
Mailing Address - Fax:
Practice Address - Street 1:491 US ROUTE 1 STE 23
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-7022
Practice Address - Country:US
Practice Address - Phone:207-200-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC22371104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty