Provider Demographics
NPI:1003524307
Name:COLEMAN, MIRACLE JADE (LMSW, MPH, MA)
Entity type:Individual
Prefix:
First Name:MIRACLE
Middle Name:JADE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMSW, MPH, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 LINCOLN PL # 180
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6201
Mailing Address - Country:US
Mailing Address - Phone:206-310-8745
Mailing Address - Fax:
Practice Address - Street 1:463 LINCOLN PL # 180
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6201
Practice Address - Country:US
Practice Address - Phone:206-310-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114531104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty