Provider Demographics
NPI:1518139765
Name:ASANBE, COMFORT BOLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:COMFORT
Middle Name:BOLA
Last Name:ASANBE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6609
Mailing Address - Country:US
Mailing Address - Phone:718-982-3780
Mailing Address - Fax:718-982-4114
Practice Address - Street 1:2800 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6609
Practice Address - Country:US
Practice Address - Phone:718-982-3780
Practice Address - Fax:718-982-4114
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017583103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist