Provider Demographics
NPI:1114197852
Name:KONSTIN, SYDNA CHRISTINE (MS COUNSELING MFT)
Entity Type:Individual
Prefix:MS
First Name:SYDNA
Middle Name:CHRISTINE
Last Name:KONSTIN
Suffix:
Gender:F
Credentials:MS COUNSELING MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STARVISTA
Mailing Address - Street 2:1021 SOUTH EL CAMINO REAL
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402
Mailing Address - Country:US
Mailing Address - Phone:650-830-1765
Mailing Address - Fax:
Practice Address - Street 1:1021 SOUTH EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402
Practice Address - Country:US
Practice Address - Phone:650-830-1765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2018-10-01
Deactivation Date:2009-08-17
Deactivation Code:
Reactivation Date:2018-09-12
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAIMF50646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist