Provider Demographics
NPI:1386636595
Name:CONSTANTINE, JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CONSTANTINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-0129
Mailing Address - Country:US
Mailing Address - Phone:317-468-6270
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:120 W MCKENZIE RD
Practice Address - Street 2:SUITE F
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1072
Practice Address - Country:US
Practice Address - Phone:317-468-6200
Practice Address - Fax:317-468-6201
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20090254A103T00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000275567OtherANTHEM PIN#
IN100232230Medicaid
IN7800235OtherAETNA PIN#
IN200459330AMedicaid
INR34334Medicare UPIN
205110JJMedicare Oscar/Certification