Healthcare Provider Details

I. General information

NPI: 1891639910
Provider Name (Legal Business Name): MAIAH CONSTANTINO LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDON CONSTANTINO

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 S GULPH RD STE 260
KING OF PRUSSIA PA
19406-3739
US

IV. Provider business mailing address

130 N 52ND ST
PHILADELPHIA PA
19139-2602
US

V. Phone/Fax

Practice location:
  • Phone: 610-803-8004
  • Fax:
Mailing address:
  • Phone: 610-803-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC002734
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: