Provider Demographics
NPI:1477121879
Name:COMER, BRENDA E (LCSW,LCAC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:E
Last Name:COMER
Suffix:
Gender:F
Credentials:LCSW,LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 W 84TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7288
Mailing Address - Country:US
Mailing Address - Phone:219-670-0365
Mailing Address - Fax:
Practice Address - Street 1:2912 W 84TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7288
Practice Address - Country:US
Practice Address - Phone:219-670-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN223945422Medicaid