Provider Demographics
NPI:1891978532
Name:COMISAR, GEORGETTE ELLEN (PCC-S)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:ELLEN
Last Name:COMISAR
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:MS
Other - First Name:GEORGETTE
Other - Middle Name:ELLEN
Other - Last Name:COMISAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PCC-S
Mailing Address - Street 1:210 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:TERRACE PARK
Mailing Address - State:OH
Mailing Address - Zip Code:45174-1112
Mailing Address - Country:US
Mailing Address - Phone:513-378-5807
Mailing Address - Fax:513-533-8851
Practice Address - Street 1:820 DELTA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45226-1221
Practice Address - Country:US
Practice Address - Phone:513-321-9902
Practice Address - Fax:513-533-8851
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0600217101YP2500X
OHE0600217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0246336Medicaid