MEDICARE: KEITH COLES LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	172V00000X	Community Health Worker
3	104100000X	Social Worker	116233	NY

General Provider Information

NPI Number	:	1265904635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH COLES LMSW

Provider Business Mailing Address
First Line	:	462 MAPLE AVE
Second Line	:
City	:	UNIONDALE
State	:	NY
Zip	:	11553-2134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	462 MAPLE AVE
Second Line	:
City	:	UNIONDALE
State	:	NY
Zip	:	11553-2134
Country	:	US
Telephone Number	:	347-204-6782
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2018
Last Update Date	:	03/14/2023

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Directions to “ KEITH COLES LMSW” Practice Location

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