Provider Demographics
NPI:1891910360
Name:CONSTANTATOS, MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:CONSTANTATOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N ALLEN DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2555
Mailing Address - Country:US
Mailing Address - Phone:972-727-3627
Mailing Address - Fax:972-390-2302
Practice Address - Street 1:400 N ALLEN DR
Practice Address - Street 2:SUITE 208
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2555
Practice Address - Country:US
Practice Address - Phone:972-727-3627
Practice Address - Fax:972-390-2302
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical