Provider Demographics
NPI:1679813398
Name:CONSTANTINO, MICHAEL JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:CONSTANTINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 HICKS WAY
Mailing Address - Street 2:TOBIN HALL, SUITE 123
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01003-9271
Mailing Address - Country:US
Mailing Address - Phone:413-545-1388
Mailing Address - Fax:413-545-0996
Practice Address - Street 1:135 HICKS WAY
Practice Address - Street 2:612 TOBIN HALL
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9271
Practice Address - Country:US
Practice Address - Phone:413-545-1388
Practice Address - Fax:413-545-0996
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical