MEDICARE: MR. PAUL COLEMAN-PSYCHE NURSE PRACTITIONER NP, PMHNP, APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN278566	MA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN278566	MA

General Provider Information

NPI Number	:	1710520333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL COLEMAN-PSYCHE NURSE PRACTITIONER NP, PMHNP, APRN

Provider Business Mailing Address
First Line	:	132 CENTRAL ST STE 107
Second Line	:
City	:	FOXBOROUGH
State	:	MA
Zip	:	02035-2422
Country	:	US
Telephone Number	:	857-201-0406
Fax Number	:	617-687-5920

Provider Business Practice Location Address
First Line	:	132 CENTRAL ST STE 107
Second Line	:
City	:	FOXBORO
State	:	MA
Zip	:	02035-2422
Country	:	US
Telephone Number	:	857-201-0406
Fax Number	:	617-687-5920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2019
Last Update Date	:	04/16/2026

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