Healthcare Provider Details

I. General information

NPI: 1811530983
Provider Name (Legal Business Name): BRETT CONSTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MARGUERITE AVE
SOUTH FLORAL PARK NY
11001-3531
US

IV. Provider business mailing address

310 MARGUERITE AVE
SOUTH FLORAL PARK NY
11001-3531
US

V. Phone/Fax

Practice location:
  • Phone: 516-761-1258
  • Fax:
Mailing address:
  • Phone: 516-761-1258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number097881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: