Provider Demographics
NPI:1164722617
Name:CONSTANTINE, JOSEPH (PHD, CCC/SLP)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:CONSTANTINE
Suffix:
Gender:M
Credentials:PHD, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 E FOWLER AVE
Mailing Address - Street 2:PCD 1017
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33620-9951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4202 E FOWLER AVE
Practice Address - Street 2:PCD 1017
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620-9951
Practice Address - Country:US
Practice Address - Phone:813-974-9814
Practice Address - Fax:813-974-0822
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002998100Medicaid
FL002998100Medicaid