Provider Demographics
NPI:1215192018
Name:DR. COLEMAN PSYCHOLOGY
Entity Type:Organization
Organization Name:DR. COLEMAN PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:772-766-4441
Mailing Address - Street 1:401 S RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-1840
Mailing Address - Country:US
Mailing Address - Phone:814-977-4417
Mailing Address - Fax:814-310-2662
Practice Address - Street 1:100 E PITT ST STE 202
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-1358
Practice Address - Country:US
Practice Address - Phone:814-977-4417
Practice Address - Fax:814-310-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS017150OtherPA LICENSE