Provider Demographics
NPI:1063118057
Name:COLEMAN, NICHOLAS PATRICK (LSW)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PATRICK
Last Name:COLEMAN
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1434
Mailing Address - Country:US
Mailing Address - Phone:570-342-8434
Mailing Address - Fax:570-299-2521
Practice Address - Street 1:470 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3603
Practice Address - Country:US
Practice Address - Phone:570-654-4357
Practice Address - Fax:570-288-1084
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140068104100000X
PACW0257631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker