Provider Demographics
NPI:1104406602
Name:COMERIE, NYKIA I
Entity type:Individual
Prefix:MISS
First Name:NYKIA
Middle Name:
Last Name:COMERIE
Suffix:I
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NYKIA
Other - Middle Name:
Other - Last Name:COMERIE
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4144 BRUNER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2028
Mailing Address - Country:US
Mailing Address - Phone:646-245-3388
Mailing Address - Fax:
Practice Address - Street 1:3250 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4500
Practice Address - Country:US
Practice Address - Phone:347-621-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3539751103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty