Provider Demographics
NPI:1720041940
Name:COLEMAN, NANCY J (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 TWIN POND RD
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-5150
Mailing Address - Country:US
Mailing Address - Phone:207-725-8514
Mailing Address - Fax:
Practice Address - Street 1:16 TWIN POND RD
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-5150
Practice Address - Country:US
Practice Address - Phone:207-725-8514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPSY00100676103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME220220000Medicaid
ME220220000Medicaid