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General NPI Number Information
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NPI Number | 1508517582
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Entity Type | Individual
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Provider Name | CONSTANTINE CHRISTODOULOU LMSW
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Gender | Male
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 28 N COUNTRY RD
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City | MOUNT SINAI
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State | NY
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Zip | 11766-1518
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Country | US
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Telephone | 607-930-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 21 COMO TER
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City | LAKE HOPATCONG
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State | NJ
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Zip | 07849-1029
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Country | US
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Telephone | 201-304-5853
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 100549
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License Number State | NY
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