Provider Demographics
NPI:1699049148
Name:COLEMAN, JOSHUA DEAN (PHD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DEAN
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOSH
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5835 COLLEGE AVE
Mailing Address - Street 2:SUITE A2
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1653
Mailing Address - Country:US
Mailing Address - Phone:510-547-6500
Mailing Address - Fax:925-258-8975
Practice Address - Street 1:5835 COLLEGE AVE
Practice Address - Street 2:SUITE A2
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1653
Practice Address - Country:US
Practice Address - Phone:510-547-6500
Practice Address - Fax:925-258-8975
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13622103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist