Provider Demographics
NPI:1407451925
Name:KOMAREK, VANESSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:KOMAREK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PANORAMA TRL STE 1120
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2432
Mailing Address - Country:US
Mailing Address - Phone:585-557-2389
Mailing Address - Fax:585-310-7165
Practice Address - Street 1:625 PANORAMA TRL STE 1120
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2432
Practice Address - Country:US
Practice Address - Phone:585-557-2389
Practice Address - Fax:585-310-7165
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP107862103T00000X
NY024800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist