Provider Demographics
NPI:1548389638
Name:COLES, JAMES LOUIS (MSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LOUIS
Last Name:COLES
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 BIDWELL PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1164
Mailing Address - Country:US
Mailing Address - Phone:716-886-1142
Mailing Address - Fax:716-886-0016
Practice Address - Street 1:142 BIDWELL PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1164
Practice Address - Country:US
Practice Address - Phone:716-886-1142
Practice Address - Fax:716-886-0016
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO1511011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB4542Medicare ID - Type Unspecified