Basic Information
| Provider Information | |||||||||
| NPI: | 1437400439 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COMAS | ||||||||
| FirstName: | SERGIO | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12055 NE 9TH AVE APT 1 | ||||||||
| Address2: | |||||||||
| City: | BISCAYNE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331616407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056092876 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 654 NE 9TH PL | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052483488 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2012 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | CBHCM100138 | 01 | FL | FLORIDA CERTIFICATION BOARD | OTHER | CBHCMS100627 | 01 | FL | FLORIDA CERTIFICATION BOARD | OTHER |