Provider Demographics
NPI:1073977708
Name:MASULLO, CONSTANTIA JO (LCSW)
Entity Type:Individual
Prefix:
First Name:CONSTANTIA
Middle Name:JO
Last Name:MASULLO
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 1:9 WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1313
Mailing Address - Country:US
Mailing Address - Phone:973-584-7339
Mailing Address - Fax:
Practice Address - Street 1:9 WALKER AVE
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1313
Practice Address - Country:US
Practice Address - Phone:973-584-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053829001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical