Provider Demographics
NPI:1871967885
Name:COLEMAN, ROBERT RUSSELL JR (MSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:RUSSELL
Last Name:COLEMAN
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 MISSION DR APT B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-3449
Mailing Address - Country:US
Mailing Address - Phone:219-433-1423
Mailing Address - Fax:
Practice Address - Street 1:3333 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4676
Practice Address - Country:US
Practice Address - Phone:317-757-8049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor