Basic Information
| Provider Information | |||||||||
| NPI: | 1760746077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLMAN | ||||||||
| FirstName: | MARY | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 KATIE CT | ||||||||
| Address2: | |||||||||
| City: | EAST HANOVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079363523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1607435416 | ||||||||
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| Practice Location | |||||||||
| Address1: | 76 W HUMBOLDT PKWY | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142142605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168359745 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2012 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 00081678 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.