Provider Demographics
NPI:1316200058
Name:COLEMAN, LEIGH ANN (MS)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 WILLIAMS WAY S
Mailing Address - Street 2:
Mailing Address - City:BAITING HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:11933-1333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:166 WILLIAMS WAY S
Practice Address - Street 2:
Practice Address - City:BAITING HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:11933-1333
Practice Address - Country:US
Practice Address - Phone:631-591-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY958889103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst