Provider Demographics
NPI:1114218815
Name:CONSTANTINE, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CONSTANTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5938
Mailing Address - Country:US
Mailing Address - Phone:207-376-3311
Mailing Address - Fax:207-786-7277
Practice Address - Street 1:800 CENTER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6404
Practice Address - Country:US
Practice Address - Phone:207-782-2726
Practice Address - Fax:207-333-3501
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1-10-7357103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1-10-7357OtherBCBA