Provider Demographics
NPI:1487979894
Name:COLEMAN, WILLIAM J
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-4438
Mailing Address - Country:US
Mailing Address - Phone:724-628-4326
Mailing Address - Fax:724-430-0821
Practice Address - Street 1:58 W MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3303
Practice Address - Country:US
Practice Address - Phone:724-430-0988
Practice Address - Fax:724-430-0821
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000195L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist