Provider Demographics
NPI:1558770131
Name:COLEMAN, BYRON SR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:
Last Name:COLEMAN
Suffix:SR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-0342
Mailing Address - Country:US
Mailing Address - Phone:914-424-0577
Mailing Address - Fax:
Practice Address - Street 1:220 SOMMERVILLE PL
Practice Address - Street 2:APT 1
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2278
Practice Address - Country:US
Practice Address - Phone:914-424-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY#092368104100000X
NY82804521411041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool