Provider Demographics
NPI:1831232487
Name:COLEMAN, PAUL D (MS, CRC, NCC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:D
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MS, CRC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-0720
Mailing Address - Country:US
Mailing Address - Phone:716-947-4166
Mailing Address - Fax:716-947-4166
Practice Address - Street 1:71 MAIN ST # 73
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:NY
Practice Address - Zip Code:14136-1446
Practice Address - Country:US
Practice Address - Phone:716-947-4166
Practice Address - Fax:716-947-4166
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003813101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003813OtherLICENSE