George V Komaridis, PH.D.. LP
Individual provider Active NPI Clinical Psychologist · Mankato, MN
NPI 1124297213 · NPPES record last updated Nov 29, 2023
Key facts
- NPI
- 1124297213
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- LP1673 (MN)
- Practice address
- 11 Civic Center PLZ Ste 2090
Mankato, MN 56001-7710 - Phone
- (507) 345-4679
- Fax
- (507) 345-8685
- NPI assigned
- Feb 22, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- University of Nebraska College of Medicine, 1969
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Addictions and Stress Clinics LTD
Practice addresses (Care Compare)
11 Civic Ctr PLZ
Suite 205
Mankato, MN 56001-7718
Phone (507) 345-4679
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130515000189 | MN | Practitioner - Clinical Psychologist | 7719124544 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP1673 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Addictions and Stress Clinics LTD | Clinical | Current |
Accepting new patients |
| Addictions & Stress Clinic | Past | Accepting new patients |
Locations
11 Civic Center Plz
Ste 205
Mankato, MN 56001
Phone (507) 345-4679
12 Civic Center Plz
Ste 1615
Mankato, MN 56001
Phone (507) 345-4679
2277 Highway 36 W
Ste 150
Saint Paul, MN 55113
Phone (507) 345-1194
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP1673 | MN | Yes |
Addresses
Primary practice location
11 Civic Center PLZ Ste 2090
Mankato, MN 56001-7710
Mailing address
11 Civic Center PLZ Ste 205
Mankato, MN 56001-7718
Phone (507) 345-4679
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 264547500 | Medicaid | MN |
Other providers in Mankato, MN
- Erin N Koehnen
- Ellen Kristine Koerner
- Meghan Kohler
- Gabrielle Danae Kolles
- Jennifer Oline Kolstad
- Lindsey Louise Konchar
- Alyce Lorayne Konz
- Rebecca Konz
- Tyler J Koonst
- Naga Pradyumna Kothapalli
All providers in Mankato, MN · Clinical Psychologist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.