Provider Demographics
NPI:1639644313
Name:ANDREA N CONSTANTINO
Entity Type:Organization
Organization Name:ANDREA N CONSTANTINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICSW
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSTANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-997-6519
Mailing Address - Street 1:4238 WASHINGTON ST STE 322
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2517
Mailing Address - Country:US
Mailing Address - Phone:617-997-6519
Mailing Address - Fax:
Practice Address - Street 1:4238 WASHINGTON ST STE 322
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2517
Practice Address - Country:US
Practice Address - Phone:617-997-6519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty