Provider Demographics
NPI:1497282438
Name:COLEMAN-GORSKI, KRISTA ROSE (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:ROSE
Last Name:COLEMAN-GORSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:ROSE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:3350 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1316
Mailing Address - Country:US
Mailing Address - Phone:716-835-4011
Mailing Address - Fax:716-819-3430
Practice Address - Street 1:3350 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1316
Practice Address - Country:US
Practice Address - Phone:716-835-4011
Practice Address - Fax:168-350-2537
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0901481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical