=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306505946
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH AUDREY COMER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2021
-----------------------------------------------------
Last Update Date | 01/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 WOODLAND CT STE 1
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15417-9383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-880-0740
-----------------------------------------------------
Fax | 724-603-3335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 733 CABIN HILL DR APT 2C
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-1691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-880-0740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | CW022653
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------