Healthcare Provider Details

I. General information

NPI: 1174163315
Provider Name (Legal Business Name): KERRY ELIZABETH COLEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRY ELIZABETH HELLER

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COURT STREET SUITE 42
NORWICH NY
13815
US

IV. Provider business mailing address

5 COURT STREET SUITE 42
NORWICH NY
13815
US

V. Phone/Fax

Practice location:
  • Phone: 607-337-1600
  • Fax: 607-334-4519
Mailing address:
  • Phone: 607-337-1600
  • Fax: 607-334-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101286-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: