Provider Demographics
NPI:1437634664
Name:COLEMAN, CAMYRA REBECCA (SOCIAL WORKER II)
Entity Type:Individual
Prefix:
First Name:CAMYRA
Middle Name:REBECCA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:SOCIAL WORKER II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E GILBERT ST COTTAGE #4
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0001
Mailing Address - Country:US
Mailing Address - Phone:909-677-9162
Mailing Address - Fax:
Practice Address - Street 1:1950 S SUNWEST LANE SUITE 200
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92418-0928
Practice Address - Country:US
Practice Address - Phone:909-252-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor