Provider Demographics
NPI:1235405838
Name:MILLER, CONSTANTINA (PSYD)
Entity type:Individual
Prefix:DR
First Name:CONSTANTINA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 SYCAMORE AVE
Mailing Address - Street 2:A. T. MORROW SCHOOL
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1742
Mailing Address - Country:US
Mailing Address - Phone:631-348-5109
Mailing Address - Fax:
Practice Address - Street 1:299 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1586
Practice Address - Country:US
Practice Address - Phone:631-348-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0138941103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool