Provider Demographics
NPI:1053474312
Name:CONSTANTINIDES, MARY ANN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:CONSTANTINIDES
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 38652
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231
Mailing Address - Country:US
Mailing Address - Phone:410-563-1858
Mailing Address - Fax:410-732-9201
Practice Address - Street 1:802 S BOND ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231
Practice Address - Country:US
Practice Address - Phone:410-563-1858
Practice Address - Fax:410-732-9201
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD037891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical