Mariah Lynn Komenda, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

088253 Issued in NY

Practice address

355 Central Ave
Fredonia, NY 14063-1132

Phone

(716) 672-6117

Fax

(716) 672-6120

NPI assigned

Jul 18, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649980800000",
    "number": "1770967804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "246 WAVERLY ST",
            "city": "SPRINGVILLE",
            "state": "NY",
            "postal_code": "141411060",
            "telephone_number": "716-353-2593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 CENTRAL AVE",
            "city": "FREDONIA",
            "state": "NY",
            "postal_code": "140631132",
            "telephone_number": "716-672-6117",
            "fax_number": "716-672-6120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMENDA",
        "first_name": "MARIAH",
        "middle_name": "LYNN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-18",
        "last_updated": "2022-04-15",
        "certification_date": "2022-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "72 095392",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "088253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Ihrig, OD
• Steven Ihrig, O.D.
• J & E Medical Specialties, PC
• John Jou, D.M.D.
• Alexis Kashmer
• Kara Janine Korhummel
• William J Kuwik II, LMT
• Sheila Kyser, LCSW
• Lake Erie Medical Services, PC
• Andrew James Landis, MD

• All providers in Fredonia, NY
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.