Provider Demographics
NPI:1932534146
Name:COLEMAN, JOREN ANTHONY (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JOREN
Middle Name:ANTHONY
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:427 GUY PARK AVENUE
Mailing Address - Street 2:ST. MARY'S HEALTHCARE
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-841-6824
Mailing Address - Fax:518-841-7344
Practice Address - Street 1:427 GUY PARK AVENUE
Practice Address - Street 2:SMH ADULT MENTAL HEALTH CLINIC
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010
Practice Address - Country:US
Practice Address - Phone:518-841-6824
Practice Address - Fax:518-841-7344
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086394104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker