MEDICARE: JANET D. CONSTANTINE PL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center	MH 3146	FL

General Provider Information

NPI Number	:	1124441175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANET D. CONSTANTINE PL

Provider Business Mailing Address
First Line	:	9822 TAPESTRY PARK CIR
Second Line	:	SUITE 206
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-9258
Country	:	US
Telephone Number	:	904-637-1708
Fax Number	:	904-207-7897

Provider Business Practice Location Address
First Line	:	9822 TAPESTRY PARK CIR
Second Line	:	SUITE 206
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-9258
Country	:	US
Telephone Number	:	904-637-1708
Fax Number	:	904-207-7897

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JANET DIANNE CONSTANTINE
Credential	:	LMHC CET II
Telephone Number	:	904-637-1708

Provider Enumeration Date	:	01/28/2014
Last Update Date	:	01/28/2014

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