Provider Demographics
NPI:1053454405
Name:COLEMAN, ELIZA AUGUSTA (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:AUGUSTA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 W 9TH ST
Mailing Address - Street 2:APARTMENT 11G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8977
Mailing Address - Country:US
Mailing Address - Phone:917-617-8345
Mailing Address - Fax:
Practice Address - Street 1:915 BROADWAY
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7108
Practice Address - Country:US
Practice Address - Phone:212-989-2990
Practice Address - Fax:212-260-3653
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist