MEDICARE: WALTER N COLEMAN

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	19719	NY

General Provider Information

NPI Number	:	1821301391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER N COLEMAN

Provider Business Mailing Address
First Line	:	60 FRANKLIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-1504
Country	:	US
Telephone Number	:	718-230-8600
Fax Number	:	718-228-2013

Provider Business Practice Location Address
First Line	:	60 FRANKLIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-1504
Country	:	US
Telephone Number	:	718-230-8600
Fax Number	:	718-228-2013

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

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	07/26/2010

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Directions to “ WALTER N COLEMAN ” Practice Location

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