Provider Demographics
NPI:1225212756
Name:CONSTANTINE, NAOMI RUTH (PMHNP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:RUTH
Last Name:CONSTANTINE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21955 BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-2224
Mailing Address - Country:US
Mailing Address - Phone:240-808-4418
Mailing Address - Fax:301-373-9197
Practice Address - Street 1:22590 SHADY CT
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-5009
Practice Address - Country:US
Practice Address - Phone:301-737-0500
Practice Address - Fax:301-737-3351
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR089566207Q00000X, 2084P0800X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily