Provider Demographics
NPI:1043460587
Name:WHITWOOD, CONSTANZA PATRICIA
Entity type:Individual
Prefix:MRS
First Name:CONSTANZA
Middle Name:PATRICIA
Last Name:WHITWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CONSTANZA
Other - Middle Name:PATRICIA
Other - Last Name:BLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2929 WESTMINSTER AVE UNIT 3191
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-9148
Mailing Address - Country:US
Mailing Address - Phone:562-386-5887
Mailing Address - Fax:
Practice Address - Street 1:5500 E ATHERTON ST STE 227B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4018
Practice Address - Country:US
Practice Address - Phone:562-386-5887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-20
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health