Provider Demographics
NPI:1487768990
Name:COPLEY COLEMAN, MARTHA E (LCSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:E
Last Name:COPLEY COLEMAN
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 1:104 S FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1614
Mailing Address - Country:US
Mailing Address - Phone:606-886-8572
Mailing Address - Fax:606-886-4433
Practice Address - Street 1:118 RIVER DR
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1597
Practice Address - Country:US
Practice Address - Phone:606-432-3143
Practice Address - Fax:606-437-5412
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000202644OtherANTHEM BC/BS
KY7922571OtherAETNA
KY800012730OtherRAIL ROAD MEDICARE
KY0675610Medicare ID - Type Unspecified
KY0662413Medicare ID - Type Unspecified
KY7922571OtherAETNA
KYP36815Medicare UPIN
KY0675510Medicare ID - Type Unspecified
KY0371312Medicare ID - Type Unspecified
KY800012730OtherRAIL ROAD MEDICARE
KY0675410Medicare ID - Type Unspecified
KY1266954Medicare ID - Type Unspecified
KY0653311Medicare ID - Type Unspecified