Provider Demographics
NPI:1770967804
Name:KOMENDA, MARIAH LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:LYNN
Last Name:KOMENDA
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 1:246 WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1060
Mailing Address - Country:US
Mailing Address - Phone:716-353-2593
Mailing Address - Fax:
Practice Address - Street 1:355 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1132
Practice Address - Country:US
Practice Address - Phone:716-672-6117
Practice Address - Fax:716-672-6120
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 095392104100000X
NY0882531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker