Provider Demographics
NPI:1104995158
Name:ERDMANN, CONSTANCE LYNN (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:LYNN
Last Name:ERDMANN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7925 WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2128
Mailing Address - Country:US
Mailing Address - Phone:718-264-4118
Mailing Address - Fax:
Practice Address - Street 1:400 NATTA BLVD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3137
Practice Address - Country:US
Practice Address - Phone:516-557-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2024-07-24
Deactivation Date:2016-06-14
Deactivation Code:
Reactivation Date:2018-01-17
Provider Licenses
StateLicense IDTaxonomies
NY0712221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01666971Medicaid
NYN9993N2233Medicare PIN