Healthcare Provider Details

I. General information

NPI: 1285403477
Provider Name (Legal Business Name): ANTOINNETTE COMER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 YORK RD
TIMONIUM MD
21093-2271
US

IV. Provider business mailing address

2300 YORK RD
TIMONIUM MD
21093-2271
US

V. Phone/Fax

Practice location:
  • Phone: 410-883-9929
  • Fax:
Mailing address:
  • Phone: 410-883-9929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number30912
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: