Provider Demographics
NPI:1972779676
Name:COMSTOCK, JAMES GLEN (MSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GLEN
Last Name:COMSTOCK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-3529
Mailing Address - Country:US
Mailing Address - Phone:856-968-2320
Mailing Address - Fax:856-968-2317
Practice Address - Street 1:439 CLINTON ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3529
Practice Address - Country:US
Practice Address - Phone:856-968-2320
Practice Address - Fax:856-968-2317
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001418001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical