Provider Demographics
NPI:1063512556
Name:COLEMAN, SHARON MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:MARIE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WHIPPOORWILL RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12529-6015
Mailing Address - Country:US
Mailing Address - Phone:518-325-6974
Mailing Address - Fax:518-325-9415
Practice Address - Street 1:209 WHIPPOORWILL RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NY
Practice Address - Zip Code:12529-6015
Practice Address - Country:US
Practice Address - Phone:518-325-6974
Practice Address - Fax:518-325-9415
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV279D1Medicare PIN