Provider Demographics
NPI:1144325150
Name:COLEMAN, SARA M (LISW)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:M
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7972 TYLER BLVD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4806
Mailing Address - Country:US
Mailing Address - Phone:440-974-8817
Mailing Address - Fax:440-974-6688
Practice Address - Street 1:7972 TYLER BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4806
Practice Address - Country:US
Practice Address - Phone:440-974-8817
Practice Address - Fax:440-974-6688
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00037191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000115491OtherANTHEM BCBS
5739052OtherAETNA HEALTH CARE
5739052OtherAETNA HEALTH CARE