Healthcare Provider Details

I. General information

NPI: 1306874375
Provider Name (Legal Business Name): SHARON M COLEMAN LICSW, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FLYNN AVE
BURLINGTON VT
05401-5301
US

IV. Provider business mailing address

3682 S 116 RD
BRISTOL VT
05443-5135
US

V. Phone/Fax

Practice location:
  • Phone: 802-865-6183
  • Fax:
Mailing address:
  • Phone: 802-453-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0001100
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: