Provider Demographics
NPI:1104984319
Name:CONSTANTIN-MARCONI, CORINA (PHD)
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:CONSTANTIN-MARCONI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 OLYMPIC BLVD STE 4000W
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4099
Mailing Address - Country:US
Mailing Address - Phone:424-239-9338
Mailing Address - Fax:
Practice Address - Street 1:2425 OLYMPIC BLVD STE 4000W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4099
Practice Address - Country:US
Practice Address - Phone:424-239-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical