Provider Demographics
NPI:1598995110
Name:COMAN, THERESA DURHAM (LCSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:DURHAM
Last Name:COMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 SW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4006
Mailing Address - Country:US
Mailing Address - Phone:352-374-5600
Mailing Address - Fax:352-224-2741
Practice Address - Street 1:728 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3637
Practice Address - Country:US
Practice Address - Phone:352-487-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000793471041C0700X
NY000806641041C0700X
FLSW163581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00079347Medicaid
00400166001OtherHEALTHNOW INTEGRATED
NY00080664Medicaid
NY00080664Medicaid