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General NPI Number Information
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NPI Number | 1083382337
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Entity Type | Individual
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Provider Name | KRISTY COLEMAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 2000 ALAMEDA DE LAS PULGAS STE 200
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City | SAN MATEO
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State | CA
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Zip | 94403-1293
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Country | US
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Telephone | 415-858-2584
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 ALAMEDA DE LAS PULGAS STE 200
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City | SAN MATEO
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State | CA
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Zip | 94403-1293
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | ASW87215
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW87215
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW108772
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License Number State | CA
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