Healthcare Provider Details

I. General information

NPI: 1760157317
Provider Name (Legal Business Name): DAVID COMISAR, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2021
Last Update Date: 08/14/2021
Certification Date: 08/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 E RIDGE RD
ROCHESTER NY
14622-2473
US

IV. Provider business mailing address

1880 E RIDGE RD
ROCHESTER NY
14622-2473
US

V. Phone/Fax

Practice location:
  • Phone: 585-455-1544
  • Fax:
Mailing address:
  • Phone: 585-455-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID MICHAEL COMISAR
Title or Position: OWNER
Credential: LCSW-R
Phone: 585-455-1544