Provider Demographics
NPI:1710520333
Name:COLEMAN, PAUL JOHN (PMHNP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOHN
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 CENTRAL ST STE 107
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2422
Mailing Address - Country:US
Mailing Address - Phone:857-201-0406
Mailing Address - Fax:508-530-3969
Practice Address - Street 1:132 CENTRAL ST STE 107
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2422
Practice Address - Country:US
Practice Address - Phone:857-201-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA278566163W00000X
MARN278566363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse