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General NPI Number Information
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NPI Number | 1023428984
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Entity Type | Individual
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Provider Name | MISS MICHELE MARIE COSTANZO
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Gender | Female
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 590 6TH AVE
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City | NEW YORK
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State | NY
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Zip | 10011-2019
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Country | US
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Telephone | 646-842-0153
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Fax |
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Provider Business Mailing Address
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Address Line | 508 REYNOLDS AVE
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City | BRONX
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State | NY
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Zip | 10465-3620
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Country | US
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Telephone | 646-842-0153
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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