Provider Demographics
NPI:1366035008
Name:CORONADO, CESAR ANATOLY (LSW)
Entity Type:Individual
Prefix:MR
First Name:CESAR
Middle Name:ANATOLY
Last Name:CORONADO
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:MR
Other - First Name:CESAR
Other - Middle Name:ANATOLY
Other - Last Name:CORONADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:2 RELER LN APT F
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3821
Mailing Address - Country:US
Mailing Address - Phone:631-813-0152
Mailing Address - Fax:
Practice Address - Street 1:101 MOUNTAIN CT STE 101B
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2300
Practice Address - Country:US
Practice Address - Phone:212-688-5116
Practice Address - Fax:844-236-1502
Is Sole Proprietor?:No
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06630700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker