Provider Demographics
NPI:1225322233
Name:ELISABETH CONSTANTINE, LLC
Entity Type:Organization
Organization Name:ELISABETH CONSTANTINE, LLC
Other - Org Name:ELISABETH CONSTANTINE, LPC, NBCCH, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSTANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NBCCH
Authorized Official - Phone:201-925-3550
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-0034
Mailing Address - Country:US
Mailing Address - Phone:201-925-3550
Mailing Address - Fax:877-335-3521
Practice Address - Street 1:57 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4444
Practice Address - Country:US
Practice Address - Phone:201-925-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPC0449101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty