Provider Demographics
NPI:1750379384
Name:COLEMAN, DAVID J (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 PORTAGE TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3053
Mailing Address - Country:US
Mailing Address - Phone:330-923-9344
Mailing Address - Fax:866-248-1103
Practice Address - Street 1:822 PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3053
Practice Address - Country:US
Practice Address - Phone:330-923-9344
Practice Address - Fax:866-248-1103
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4072103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0750647Medicaid
R71895Medicare UPIN
OH0750647Medicaid