Provider Demographics
NPI:1881010213
Name:CARDILLO-BACKOFF, CONSTANCE ANNE (EDD, MED)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:ANNE
Last Name:CARDILLO-BACKOFF
Suffix:
Gender:F
Credentials:EDD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 BEDFORD ST
Mailing Address - Street 2:APT. #106
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-1879
Mailing Address - Country:US
Mailing Address - Phone:781-974-6423
Mailing Address - Fax:
Practice Address - Street 1:670 BEDFORD ST
Practice Address - Street 2:APT. #106
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-1879
Practice Address - Country:US
Practice Address - Phone:781-974-6423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1134126865Medicaid