Provider Demographics
NPI:1881981041
Name:MENNELLA, CONSTANCE (DO)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:
Last Name:MENNELLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:57 W 57TH ST
Mailing Address - Street 2:SUITE 912
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2802
Mailing Address - Country:US
Mailing Address - Phone:855-767-7287
Mailing Address - Fax:646-687-7893
Practice Address - Street 1:57 W 57TH ST
Practice Address - Street 2:SUITE 912
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:855-767-7287
Practice Address - Fax:646-687-7893
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28312712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry