Provider Demographics
NPI:1063819845
Name:COLOMA, JEOVANNA NATHALIE (LCSW)
Entity type:Individual
Prefix:
First Name:JEOVANNA
Middle Name:NATHALIE
Last Name:COLOMA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-6566
Mailing Address - Country:US
Mailing Address - Phone:929-296-6790
Mailing Address - Fax:
Practice Address - Street 1:4902 QUEENS BLVD STE 2
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4445
Practice Address - Country:US
Practice Address - Phone:929-296-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-22
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095941104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker