MEDICARE: MRS. KIM MARIE COLEMAN 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	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1396917472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIM MARIE COLEMAN LMSW

Provider Business Mailing Address
First Line	:	430 NIAGARA ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14201-1886
Country	:	US
Telephone Number	:	716-853-1335
Fax Number	:	716-853-1598

Provider Business Practice Location Address
First Line	:	430 NIAGARA ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14201-1886
Country	:	US
Telephone Number	:	716-853-1335
Fax Number	:	716-853-1598

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

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	03/28/2008

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