Provider Demographics
NPI:1104394238
Name:COMETTANT, EILEEN P MCMANUS (LICSW)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:P MCMANUS
Last Name:COMETTANT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ADAMS LN
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-2018
Mailing Address - Country:US
Mailing Address - Phone:508-358-3851
Mailing Address - Fax:
Practice Address - Street 1:40 ADAMS LN
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-2018
Practice Address - Country:US
Practice Address - Phone:508-358-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041S0200X
MA10243731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool