Provider Demographics
NPI:1780030767
Name:COLEMAN, BERNARD
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-2601
Mailing Address - Country:US
Mailing Address - Phone:617-371-1720
Mailing Address - Fax:617-371-1846
Practice Address - Street 1:17 COURT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-2601
Practice Address - Country:US
Practice Address - Phone:617-371-1720
Practice Address - Fax:617-371-1846
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA$$$$$$$$$Other$$$$$$$$$