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NPI Code Detail

MEDICARE: LATISHA COLEMAN

MEDICARE: LATISHA COLEMAN
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1528637584
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATISHA COLEMAN
Provider Business Mailing Address
First Line : 9206 196TH ST APT B3
Second Line :
City : HOLLIS
State : NY
Zip : 11423-2661
Country : US
Telephone Number : 646-881-2521
Fax Number :
Provider Business Practice Location Address
First Line : 6603 BEACH CHANNEL DR
Second Line :
City : ARVERNE
State : NY
Zip : 11692-1433
Country : US
Telephone Number : 718-471-8671
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2021
Last Update Date : 06/23/2021

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Directions to “ LATISHA COLEMAN ” Practice Location

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