Healthcare Provider Details

I. General information

NPI: 1801784764
Provider Name (Legal Business Name): DR. RENEE ALLEYNE COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WOODSMEADOW LN
ROCHESTER NY
14623-2741
US

IV. Provider business mailing address

103 WOODSMEADOW LN
ROCHESTER NY
14623-2741
US

V. Phone/Fax

Practice location:
  • Phone: 804-677-3834
  • Fax:
Mailing address:
  • Phone: 804-677-3834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number018741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: