Provider Demographics
NPI:1700959012
Name:COMSTOCK, LOREN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOREN
Middle Name:
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CENTRAL PARK S
Mailing Address - Street 2:APT 2H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1435
Mailing Address - Country:US
Mailing Address - Phone:212-974-7251
Mailing Address - Fax:212-308-2202
Practice Address - Street 1:240 CENTRAL PARK S
Practice Address - Street 2:APT 2H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1435
Practice Address - Country:US
Practice Address - Phone:212-974-7251
Practice Address - Fax:212-308-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR056628-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNON451Medicare ID - Type Unspecified