Provider Demographics
NPI:1275607681
Name:COLEMAN, JUDITH (MA)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CAPITAL VALLEY COUNSELING ASSOCIATES INC
Mailing Address - Street 2:8 CENTRE STREET SUITE 2
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-6302
Mailing Address - Country:US
Mailing Address - Phone:603-228-7300
Mailing Address - Fax:603-228-7301
Practice Address - Street 1:CVCA INC
Practice Address - Street 2:8 CENTRE STREET SUITE 2
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-6302
Practice Address - Country:US
Practice Address - Phone:603-228-7300
Practice Address - Fax:603-228-7301
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH114 LCMHC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009470Medicaid
NHHPHC015022OtherHARVARD PILGRIM
NH144000984NH01OtherANTHEM