Provider Demographics
NPI:1336244805
Name:COMSTOCK, MARILYN C (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:C
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LYNN
Other - Middle Name:C
Other - Last Name:COMSTOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4051 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1846
Mailing Address - Country:US
Mailing Address - Phone:724-327-6010
Mailing Address - Fax:
Practice Address - Street 1:4051 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1846
Practice Address - Country:US
Practice Address - Phone:724-327-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003882L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000678529Medicare UPIN
PA000678529Medicare ID - Type Unspecified