Healthcare Provider Details

I. General information

NPI: 1609880822
Provider Name (Legal Business Name): ROGER DEAN COLEMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ROCKWOOD LN
HAZARD KY
41701-9415
US

IV. Provider business mailing address

115 ROCKWOOD LN
HAZARD KY
41701-9415
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-5761
  • Fax: 606-435-0817
Mailing address:
  • Phone: 606-436-5761
  • Fax: 606-435-0817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1854
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: