Basic Information
| Provider Information | |||||||||
| NPI: | 1841882727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONSTANOS | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 E END BLVD | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187110030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708243521 | ||||||||
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| Practice Location | |||||||||
| Address1: | 156 SARA LN | ||||||||
| Address2: | |||||||||
| City: | SHOHOLA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184583910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562873112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2021 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 083237 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.