Provider Demographics
NPI:1821378134
Name:COLEMAN, JENNIFER M (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 FABER CIR
Mailing Address - Street 2:
Mailing Address - City:TANNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18372-9086
Mailing Address - Country:US
Mailing Address - Phone:908-310-9450
Mailing Address - Fax:
Practice Address - Street 1:3201 HIGHFIELD DRIVE
Practice Address - Street 2:ST. M
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020
Practice Address - Country:US
Practice Address - Phone:908-310-9450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
PAPC006716101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst