Provider Demographics
NPI:1821448549
Name:COLEMAN, SHAUNCEY (MSW)
Entity Type:Individual
Prefix:
First Name:SHAUNCEY
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 BRIGHAM HILL RD.
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519
Mailing Address - Country:US
Mailing Address - Phone:508-887-6554
Mailing Address - Fax:
Practice Address - Street 1:340 MAIN ST.
Practice Address - Street 2:SUITE NUMBER 818
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-791-4976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical