1184401903 NPI number — FALISHA SMITH-COACHMAN MSW, LSW

Table of content: FALISHA SMITH-COACHMAN MSW, LSW (NPI 1184401903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184401903 NPI number — FALISHA SMITH-COACHMAN MSW, LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH-COACHMAN
Provider First Name:
FALISHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184401903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1262 CLOVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG POND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18334-7892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-909-2634
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
529 SEVEN BRIDGE RD UNIT 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18301-7608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-807-0267
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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