Provider Demographics
NPI:1629696380
Name:DELOSSANTOS COLEMAN, BETTY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:
Last Name:DELOSSANTOS COLEMAN
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 1:312 HAYWARD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1607
Mailing Address - Country:US
Mailing Address - Phone:646-522-4241
Mailing Address - Fax:
Practice Address - Street 1:312 HAYWARD AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-1607
Practice Address - Country:US
Practice Address - Phone:646-522-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0736051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical