Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 44SL05701900 | NJ |
NPI | 1003194473 |
---|---|
Provider Name | Angela R. Constantino |
First Address | Rockaway, NJ 07866-4024 |
Second Address | Rockaway, NJ 07866-4024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2011 |
Last Update Date | 07/08/2020 |