Provider Demographics
NPI:1235273400
Name:COMFORT, GINA CASSIDY (LCSWR, CASAC)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:CASSIDY
Last Name:COMFORT
Suffix:
Gender:F
Credentials:LCSWR, CASAC
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:CASSIDY- COMFORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSWR, CASAC
Mailing Address - Street 1:7 KARI BLVD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6308
Mailing Address - Country:US
Mailing Address - Phone:845-471-0062
Mailing Address - Fax:845-471-1132
Practice Address - Street 1:202 HOOKER AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-3329
Practice Address - Country:US
Practice Address - Phone:845-473-2175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6611101YA0400X
NYRO27754-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health