Provider Demographics
NPI:1891978532
Name:COMISAR, GEORGETTE ELLEN (PCC-S)
Entity Type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:ELLEN
Last Name:COMISAR
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:MS
Other - First Name:GEORGETTE
Other - Middle Name:ELLEN
Other - Last Name:COMISAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PCC-S
Mailing Address - Street 1:375 DIXMYTH AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2475
Mailing Address - Country:US
Mailing Address - Phone:513-862-3512
Mailing Address - Fax:
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-862-3512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0600217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0246336Medicaid