Provider Demographics
NPI:1386786895
Name:JAMES L COLES LCSW, PC
Entity type:Organization
Organization Name:JAMES L COLES LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:COLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:716-472-5962
Mailing Address - Street 1:5598 DUTCH ST
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:NY
Mailing Address - Zip Code:14837-9746
Mailing Address - Country:US
Mailing Address - Phone:716-472-5962
Mailing Address - Fax:716-387-9696
Practice Address - Street 1:1 KEUKA BUSINESS PARK
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527
Practice Address - Country:US
Practice Address - Phone:716-472-5962
Practice Address - Fax:716-387-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR00224151104100000X
NYPR0151101104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB4542Medicare ID - Type Unspecified