Provider Demographics
NPI:1669636734
Name:CONSTANTINIDES, DAMON (MSW, LSW, PHD)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:CONSTANTINIDES
Suffix:
Gender:M
Credentials:MSW, LSW, PHD
Other - Prefix:
Other - First Name:DAMON
Other - Middle Name:
Other - Last Name:CONSTANTINIDES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW, PHD
Mailing Address - Street 1:1315 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5601
Mailing Address - Country:US
Mailing Address - Phone:607-592-2173
Mailing Address - Fax:
Practice Address - Street 1:1315 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5601
Practice Address - Country:US
Practice Address - Phone:607-592-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CW0172181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical