Provider Demographics
NPI:1043719347
Name:KALLINTERIS, CONSTANTINA IRENE (LCSW)
Entity Type:Individual
Prefix:
First Name:CONSTANTINA
Middle Name:IRENE
Last Name:KALLINTERIS
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 1:116 RENASTAR RD
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7208
Mailing Address - Country:US
Mailing Address - Phone:570-420-7525
Mailing Address - Fax:
Practice Address - Street 1:116 RENASTAR RD
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7208
Practice Address - Country:US
Practice Address - Phone:570-977-1384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA130044104100000X
PACW02044991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker