Healthcare Provider Details

I. General information

NPI: 1073663456
Provider Name (Legal Business Name): DAVID MICHAEL COMISAR LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 RIDGE RD E
ROCHESTER NY
14622-2473
US

IV. Provider business mailing address

65 VIENNAWOOD DR
ROCHESTER NY
14618-4464
US

V. Phone/Fax

Practice location:
  • Phone: 585-455-1544
  • Fax:
Mailing address:
  • Phone: 585-271-3659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073315
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: