Provider Demographics
NPI:1861631160
Name:MEDLEY, CONSTANCE YOUNG (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:YOUNG
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:MRS
Other - First Name:CONSTANCE
Other - Middle Name:ANN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:C-07473
Mailing Address - Street 1:2514 W CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-2261
Mailing Address - Country:US
Mailing Address - Phone:575-626-5406
Mailing Address - Fax:
Practice Address - Street 1:1106 W QUAY AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1826
Practice Address - Country:US
Practice Address - Phone:575-746-2777
Practice Address - Fax:575-746-2778
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-074731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical