Lifespan Wellness Marriage & Family Therapy PLLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

001372 Issued in NY

Legal business name

LIFESPAN WELLNESS MARRIAGE & FAMILY THERAPY PLLC

Practice address

21333 39TH Ave Ste 235
Bayside, NY 11361-2174

Phone

(917) 913-6441

NPI assigned

Aug 24, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Maria Constantinou, LMFTNPI 1730626896

Title

Director

Phone

(917) 913-6441

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maria Constantinou, MFT

  • Marriage & Family Therapist
  • Flushing, NY
  • NPI 1730626896
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543536000000",
    "number": "1982185161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2608 BAYSIDE LN",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113581054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21333 39TH AVE STE 235",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113612174",
            "telephone_number": "917-913-6441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2391 Bell Blvd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Flushing",
            "state": "NY",
            "postal_code": "113602019",
            "country_code": "US",
            "telephone_number": "917-913-6441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFESPAN WELLNESS MARRIAGE & FAMILY THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-24",
        "last_updated": "2018-11-30",
        "status": "A",
        "authorized_official_last_name": "CONSTANTINOU",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "917-913-6441",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "NY",
            "license": "001372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1730626896",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Bayside, NY
• Providers in Bayside, NY by specialty
• Marriage & Family Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.