Healthcare Provider Details

I. General information

NPI: 1417703000
Provider Name (Legal Business Name): ALEXANDRA COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 MADISON AVE FL 22
NEW YORK NY
10017-6368
US

IV. Provider business mailing address

500 E 77TH ST APT 2523
NEW YORK NY
10162-0028
US

V. Phone/Fax

Practice location:
  • Phone: 415-360-3833
  • Fax:
Mailing address:
  • Phone: 551-206-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088799
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: