Individual
JACK KOMEJAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
34TH AND CIVIC CENTER BOULEVARD, PHILADELPHIA, PA 19104-4399
(215) 590-1136
Mailing address
402 W DURHAM ST, PHILADELPHIA, PA 19119-2910
(650) 218-8293
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCS012339
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LS012339
CALIFORNIA BOARD OF BEHAVIORAL SCIENCES
CA
Enumeration date
06/02/2016
Last updated
06/02/2016
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