Provider Demographics
NPI:1205103314
Name:COLEMAN, MICHELLE LEOMA (PHD)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LEOMA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 PAPERMILL RD
Mailing Address - Street 2:POST ACUTE CARE CENTER
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2802 PAPERMILL RD
Practice Address - Street 2:POST ACUTE CARE CENTER
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1065
Practice Address - Country:US
Practice Address - Phone:484-628-2542
Practice Address - Fax:484-628-2688
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA334217OtherMEDICARE PTAN
PA102889094Medicaid