Provider Demographics
NPI:1801237524
Name:COMISSO, CONSUELO (MS)
Entity type:Individual
Prefix:MRS
First Name:CONSUELO
Middle Name:
Last Name:COMISSO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9135 SW 148TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4130
Mailing Address - Country:US
Mailing Address - Phone:786-306-3657
Mailing Address - Fax:
Practice Address - Street 1:169 E FLAGLER ST STE 1300
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-1205
Practice Address - Country:US
Practice Address - Phone:786-306-3657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health