Provider Demographics
NPI:1225889306
Name:COLEMAN, ANDREA ELEASE (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELEASE
Last Name:COLEMAN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 PUTNAM BLVD # 1212
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1079
Mailing Address - Country:US
Mailing Address - Phone:860-773-4048
Mailing Address - Fax:
Practice Address - Street 1:365 MAIN ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2665
Practice Address - Country:US
Practice Address - Phone:860-248-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT137411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical