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General NPI Number Information
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NPI Number | 1225889306
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Entity Type | Individual
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Provider Name | ANDREA ELEASE COLEMAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 365 MAIN ST
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City | BERLIN
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State | CT
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Zip | 06037-2665
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Country | US
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Telephone | 860-248-6004
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Fax |
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Provider Business Mailing Address
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Address Line | 49 PUTNAM BLVD # 1212
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City | GLASTONBURY
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State | CT
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Zip | 06033-1079
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Country | US
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Telephone | 860-773-4048
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13741
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License Number State | CT
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