Provider Demographics
NPI:1619268083
Name:FLUCUS, CONSTANCE MICHELLE (ABA)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:MICHELLE
Last Name:FLUCUS
Suffix:
Gender:F
Credentials:ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 E TREMONT AVE
Mailing Address - Street 2:2 FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5700
Mailing Address - Country:US
Mailing Address - Phone:718-239-8239
Mailing Address - Fax:718-770-7686
Practice Address - Street 1:3175 E TREMONT AVE
Practice Address - Street 2:2 FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5700
Practice Address - Country:US
Practice Address - Phone:718-239-8239
Practice Address - Fax:718-770-7686
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105889103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst