MEDICARE: ROBERT COLEMAN PSYD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY8157	FL

General Provider Information

NPI Number	:	1295097368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT COLEMAN PSYD LLC

Provider Business Mailing Address
First Line	:	11200 SEMINOLE BLVD STE 101
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778-3240
Country	:	US
Telephone Number	:	727-272-0097
Fax Number	:

Provider Business Practice Location Address
First Line	:	11200 SEMINOLE BLVD STE 101
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778-3240
Country	:	US
Telephone Number	:	727-272-0097
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT M COLEMAN
Credential	:	PSYD
Telephone Number	:	727-272-0097

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	06/27/2023

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