Healthcare Provider Details

I. General information

NPI: 1063069243
Provider Name (Legal Business Name): JESSICA R. COLEMAN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 VIRGINIA AVE NW
WASHINGTON DC
20037-1905
US

IV. Provider business mailing address

2600 VIRGINIA AVE NW
WASHINGTON DC
20037-1905
US

V. Phone/Fax

Practice location:
  • Phone: 202-265-5477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: