Healthcare Provider Details

I. General information

NPI: 1063118057
Provider Name (Legal Business Name): NICHOLAS PATRICK COLEMAN LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 WYOMING AVE
KINGSTON PA
18704-3603
US

IV. Provider business mailing address

1251 WYOMING AVE
EXETER PA
18643-1434
US

V. Phone/Fax

Practice location:
  • Phone: 570-654-4357
  • Fax: 570-288-1084
Mailing address:
  • Phone: 570-342-8434
  • Fax: 570-299-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW140068
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW025763
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: