Provider Demographics
NPI:1588682330
Name:DROSSOS, CONSTANCE N (PHD)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:N
Last Name:DROSSOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:DROSSOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1103 S ROBERT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-4535
Mailing Address - Country:US
Mailing Address - Phone:773-807-5103
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:STE MC 3077
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-2995
Practice Address - Fax:773-702-6649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical