Healthcare Provider Details

I. General information

NPI: 1932138260
Provider Name (Legal Business Name): PAUL JAMES KOMATINSKY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 MAIN ST
BINGHAMTON NY
13905-2522
US

IV. Provider business mailing address

257 MAIN ST
BINGHAMTON NY
13905-2522
US

V. Phone/Fax

Practice location:
  • Phone: 607-729-6206
  • Fax: 607-729-1858
Mailing address:
  • Phone: 607-729-6206
  • Fax: 607-729-1858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR045764
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: