Provider Demographics
NPI:1497826929
Name:COLEMAN, BARBARA MANDELKORN (BARBARA COLEMAN)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:MANDELKORN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:BARBARA COLEMAN
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:MANDELKORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BARBARA COLEMAN
Mailing Address - Street 1:331 AUBURNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1213
Mailing Address - Country:US
Mailing Address - Phone:617-964-1026
Mailing Address - Fax:
Practice Address - Street 1:331 AUBURNDALE AVE
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-1213
Practice Address - Country:US
Practice Address - Phone:617-964-1026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1699103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA W01617OtherPSYCHOLOGIST PROVIDER NO.
MACO W51116Medicare ID - Type UnspecifiedPSYCHOLOGIST PROVIDER NO.