Provider Demographics
NPI:1326883695
Name:COMERFORD, THOMAS EDISON III (MASTERS OF SCIENCE)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDISON
Last Name:COMERFORD
Suffix:III
Gender:M
Credentials:MASTERS OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1307
Mailing Address - Country:US
Mailing Address - Phone:607-349-8600
Mailing Address - Fax:
Practice Address - Street 1:512 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1307
Practice Address - Country:US
Practice Address - Phone:607-349-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY646192951103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool