Provider Demographics
NPI:1780123240
Name:COLEMAN, JABINA (LSW, IBCLC)
Entity type:Individual
Prefix:
First Name:JABINA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LSW, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4235
Mailing Address - Country:US
Mailing Address - Phone:215-300-7609
Mailing Address - Fax:
Practice Address - Street 1:5415 CATHARINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-2509
Practice Address - Country:US
Practice Address - Phone:215-300-7609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000OtherNOT APPLICABLE