Provider Demographics
NPI:1790191930
Name:COLEMAN, CAROL (LSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3906
Mailing Address - Country:US
Mailing Address - Phone:201-395-4812
Mailing Address - Fax:201-435-9580
Practice Address - Street 1:285 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3906
Practice Address - Country:US
Practice Address - Phone:201-395-4812
Practice Address - Fax:201-435-9580
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05865500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker