Provider Demographics
NPI:1730896838
Name:COLEMAN, DESIREE (MFT)
Entity type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3303
Mailing Address - Country:US
Mailing Address - Phone:267-423-4123
Mailing Address - Fax:
Practice Address - Street 1:715 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3303
Practice Address - Country:US
Practice Address - Phone:908-242-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist