MEDICARE: DR. MARY CATHERINE COMMERFORD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	012270-1	NY

General Provider Information

NPI Number	:	1649399510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY CATHERINE COMMERFORD PH.D.

Provider Business Mailing Address
First Line	:	180 COW NECK RD
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1102
Country	:	US
Telephone Number	:	917-623-9204
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 RIVERSIDE DR STE 1R
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-2605
Country	:	US
Telephone Number	:	917-406-7287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	10/15/2024

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