Provider Demographics
NPI:1609160191
Name:LORA COLEMAN, LCSW, PA
Entity Type:Organization
Organization Name:LORA COLEMAN, LCSW, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, DNH
Authorized Official - Phone:305-298-6561
Mailing Address - Street 1:20230 SW 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1313
Mailing Address - Country:US
Mailing Address - Phone:305-298-6561
Mailing Address - Fax:786-293-9985
Practice Address - Street 1:10700 CARIBBEAN BLVD STE 203
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1224
Practice Address - Country:US
Practice Address - Phone:305-298-6561
Practice Address - Fax:305-969-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW79781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000031800Medicaid