Provider Demographics
NPI:1083009732
Name:CONSTANTINER, MELISSA RAQUEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:RAQUEL
Last Name:CONSTANTINER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8838
Mailing Address - Country:US
Mailing Address - Phone:917-974-7333
Mailing Address - Fax:
Practice Address - Street 1:2 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8838
Practice Address - Country:US
Practice Address - Phone:917-974-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021089103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical