Provider Demographics
NPI:1508517582
Name:CHRISTODOULOU, CONSTANTINE (LMSW)
Entity Type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:
Last Name:CHRISTODOULOU
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 68TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5722
Mailing Address - Country:US
Mailing Address - Phone:201-304-5853
Mailing Address - Fax:
Practice Address - Street 1:28 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-1518
Practice Address - Country:US
Practice Address - Phone:607-930-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1152471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical