Provider Demographics
NPI:1073162814
Name:COLEMAN, LYLANIN Y
Entity Type:Individual
Prefix:
First Name:LYLANIN
Middle Name:Y
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYLANNA
Other - Middle Name:Y
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4225 NW 109TH TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7995
Mailing Address - Country:US
Mailing Address - Phone:954-901-9282
Mailing Address - Fax:
Practice Address - Street 1:4225 NW 109TH TER
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7995
Practice Address - Country:US
Practice Address - Phone:954-901-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst