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NPI Code Detail

MEDICARE: ROBERT COMERFORD LCSW

MEDICARE:   ROBERT  COMERFORD  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker2013020801MO

General Provider Information

NPI Number : 1073861514
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT COMERFORD LCSW
Provider Business Mailing Address
First Line : 203 N GRAND ST
Second Line :
City : SALEM
State : MO
Zip : 65560-1344
Country : US
Telephone Number : 573-729-4103
Fax Number : 573-729-4420
Provider Business Practice Location Address
First Line : 203 N GRAND ST
Second Line :
City : SALEM
State : MO
Zip : 65560-1344
Country : US
Telephone Number : 573-729-4103
Fax Number : 573-729-4420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2012
Last Update Date : 09/25/2013

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