Provider Demographics
NPI:1518574565
Name:COLEMAN, MARY JEAN (MSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JEAN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11618 WHITE ASH DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-1934
Mailing Address - Country:US
Mailing Address - Phone:727-857-3610
Mailing Address - Fax:
Practice Address - Street 1:11618 WHITE ASH DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-1934
Practice Address - Country:US
Practice Address - Phone:727-857-3610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker