Provider Demographics
NPI:1932267853
Name:OSIECKI, CONSTANCE M (PC)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:M
Last Name:OSIECKI
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1943 OXFORD STREET
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505
Mailing Address - Country:US
Mailing Address - Phone:814-882-4300
Mailing Address - Fax:814-725-9189
Practice Address - Street 1:1943 OXFORD ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4648
Practice Address - Country:US
Practice Address - Phone:814-882-4300
Practice Address - Fax:814-725-9189
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003806101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)