Individual provider Active NPI

Jeovanna Nathalie Coloma, LCSW

  • Social Worker
  • Woodside, NY
National Provider Identifier
1063819845
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
095941 Issued in NY
Practice address
4902 Queens Blvd Ste 2
Woodside, NY 11377-4445
Phone
(929) 296-6790
NPI assigned
Nov 22, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 095941 NY Primary

Addresses

Primary practice location

4902 Queens Blvd Ste 2
Woodside, NY 11377-4445

Mailing address

310 Saint Nicholas Ave
Brooklyn, NY 11237-6566
Phone (929) 296-6790

Other practice location 1

310 Saint Nicholas Ave
Brooklyn, NY 11237-6566
Phone (929) 296-6790

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250915000656 NY Practitioner - Clinical Social Worker 2769985704 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4902 Queens Blvd
Suite 2
Woodside, NY 11377-4445

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
095941NYMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Lifeskills Counseling Services LCSW, P.C. CurrentSince Jun 7, 2025 Accepting new patients

Locations

310 Saint Nicholas Ave
Ste 1
Brooklyn, NY 11237
Phone (929) 296-6790

4902 Queens Blvd
Ste 2
Woodside, NY 11377
Phone (929) 296-6790

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1063819845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 SAINT NICHOLAS AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112376566",
            "telephone_number": "929-296-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4902 QUEENS BLVD STE 2",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113774445",
            "telephone_number": "929-296-6790"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 Saint Nicholas Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112376566",
            "country_code": "US",
            "telephone_number": "929-296-6790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLOMA",
        "first_name": "JEOVANNA",
        "middle_name": "NATHALIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-22",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "095941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodside, NY

Sources for this page

Verify at the official NPI Registry.