Healthcare Provider Details

I. General information

NPI: 1689241655
Provider Name (Legal Business Name): FRANCIS MARIA COLES LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 12/18/2022
Certification Date: 12/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAG CAMP HUMPHREYS UNIT #15245 BLDG 3030
APO AP
96271-5245
US

IV. Provider business mailing address

PSC 444 BOX 2451
APO AP
96297-0025
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-1921
  • Fax:
Mailing address:
  • Phone: 253-686-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012517
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60958657
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: