=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710443718
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARIFA CONSTANTINE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2019
-----------------------------------------------------
Last Update Date | 01/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 224 ALEXANDER ST STE 100
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14607-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-922-7770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7410 FOREST TRL APT 406
-----------------------------------------------------
City | VICTOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14564-9655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 101586
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------