MEDICARE: JACINTA A. COLEMAN MSW, LICSW

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	1041C0700X	Clinical Social Worker	302697	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24088	OTHER	DC	CLINICAL SOCIAL WORKER
2	268813	OTHER	DC	CLINICAL SOCIAL WORKER
3	5418	OTHER	DC	CLINICAL SOCIAL WORKER
4	M36800001	OTHER	DC	SOCIAL WORKER CLINICAL

General Provider Information

NPI Number	:	1710921762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACINTA A. COLEMAN MSW, LICSW

Provider Business Mailing Address
First Line	:	3825 17TH PL NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-2313
Country	:	US
Telephone Number	:	202-529-1572
Fax Number	:	202-529-0105

Provider Business Practice Location Address
First Line	:	3825 17TH PL NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-2313
Country	:	US
Telephone Number	:	202-529-1572
Fax Number	:	202-529-0105

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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