Healthcare Provider Details

I. General information

NPI: 1750543104
Provider Name (Legal Business Name): COLEMAN HUTCHINS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W 34TH ST
NEW YORK NY
10001-3006
US

IV. Provider business mailing address

19 W 34TH ST
NEW YORK NY
10001-3006
US

V. Phone/Fax

Practice location:
  • Phone: 212-947-7111
  • Fax:
Mailing address:
  • Phone: 212-947-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR051645-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: