Provider Demographics
NPI:1487995171
Name:KONSTANTAKOS, NIKOLAOS (MHC)
Entity type:Individual
Prefix:MR
First Name:NIKOLAOS
Middle Name:
Last Name:KONSTANTAKOS
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 77TH ST
Mailing Address - Street 2:APT C3
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1251
Mailing Address - Country:US
Mailing Address - Phone:917-892-6018
Mailing Address - Fax:
Practice Address - Street 1:2231 77TH ST
Practice Address - Street 2:APT C3
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1251
Practice Address - Country:US
Practice Address - Phone:917-892-6018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP86099101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health