Provider Demographics
NPI:1891286399
Name:COMA, MARIE (MED)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:COMA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MCCREADY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2751
Mailing Address - Country:US
Mailing Address - Phone:412-848-2470
Mailing Address - Fax:
Practice Address - Street 1:4229 BARDSTOWN RD STE 126
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3284
Practice Address - Country:US
Practice Address - Phone:502-416-1416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional