Provider Demographics
NPI:1306838057
Name:KASH, CONSTANCE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:M
Last Name:KASH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15 HARBOR N
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3843
Mailing Address - Country:US
Mailing Address - Phone:631-332-9534
Mailing Address - Fax:516-755-3575
Practice Address - Street 1:910 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-4927
Practice Address - Country:US
Practice Address - Phone:631-332-9534
Practice Address - Fax:516-755-3575
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034679-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
075390OtherCHAMPUS/TRICARE
NY015488104927Medicaid
NY01548810Medicaid
P406493OtherOXFORD
NY01548810Medicaid