Provider Demographics
NPI:1558469346
Name:GULINO, CONSTANCE ANN (LCSWR, CASAC)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:ANN
Last Name:GULINO
Suffix:
Gender:F
Credentials:LCSWR, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 KENNISON PKWY
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3117
Mailing Address - Country:US
Mailing Address - Phone:716-228-1329
Mailing Address - Fax:716-648-2760
Practice Address - Street 1:162 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4917
Practice Address - Country:US
Practice Address - Phone:716-228-1329
Practice Address - Fax:716-648-2760
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04262011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000250811010OtherUNIVERA BEHAVIORAL HEALTH
NY000525494001OtherBLUE CROSS AND BLUE SHIEL
NY62126787OtherINDEPENDENT HEALTH
NY10768073OtherCAQH
NY10768073OtherCAQH