Healthcare Provider Details

I. General information

NPI: 1932859204
Provider Name (Legal Business Name): FILIPPO JOSEPH COSTANZO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 BLACK PINE CT
MADISONVILLE LA
70447-3283
US

IV. Provider business mailing address

1525 BLACK PINE CT
MADISONVILLE LA
70447-3283
US

V. Phone/Fax

Practice location:
  • Phone: 985-687-0696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34.017474
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number353581
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS025037
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: