Healthcare Provider Details

I. General information

NPI: 1396806030
Provider Name (Legal Business Name): JOSEPH EDWARD COMATY PH.D., M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 CALAIS CIR
HIGHLAND PARK IL
60035-3920
US

IV. Provider business mailing address

1451 CALAIS CIR
HIGHLAND PARK IL
60035-3920
US

V. Phone/Fax

Practice location:
  • Phone: 225-936-5458
  • Fax:
Mailing address:
  • Phone: 225-936-5458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071.010829
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number682
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number682
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number071.010829
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number682
License Number StateLA
# 6
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number682MP
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: