Provider Demographics
NPI:1538787379
Name:COLEMAN, KRISTINA EMMA (LMSW ,MPA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:EMMA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMSW ,MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DASSERN DR # I
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-3131
Mailing Address - Country:US
Mailing Address - Phone:914-562-7694
Mailing Address - Fax:
Practice Address - Street 1:10 DASSERN DR # I
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-3131
Practice Address - Country:US
Practice Address - Phone:914-562-7694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000OtherN/A