Healthcare Provider Details

I. General information

NPI: 1598921421
Provider Name (Legal Business Name): BRIGITTE CONSTABLE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 GOLDEN HILL LN
KINGSTON NY
12401-6441
US

IV. Provider business mailing address

8 TILLSON RD
TILLSON NY
12486-1611
US

V. Phone/Fax

Practice location:
  • Phone: 845-340-4116
  • Fax:
Mailing address:
  • Phone: 845-658-3496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079815-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: