Provider Demographics
NPI:1609295120
Name:COLEMAN, SHAKESHA (MSW)
Entity Type:Individual
Prefix:MS
First Name:SHAKESHA
Middle Name:
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 1:200 FALLS BLVD UNIT A105
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-8145
Mailing Address - Country:US
Mailing Address - Phone:718-541-8772
Mailing Address - Fax:
Practice Address - Street 1:200 FALLS BLVD
Practice Address - Street 2:A105
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-8158
Practice Address - Country:US
Practice Address - Phone:347-709-1327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-11
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker