Provider Demographics
NPI:1154550127
Name:DEFREEST, CONSTANCE (MS, NP)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:DEFREEST
Suffix:
Gender:F
Credentials:MS, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 ROUTE 9
Mailing Address - Street 2:SUITE 7B
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4993
Mailing Address - Country:US
Mailing Address - Phone:845-632-2939
Mailing Address - Fax:845-632-2940
Practice Address - Street 1:1285 ROUTE 9
Practice Address - Street 2:SUITE 7B
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4993
Practice Address - Country:US
Practice Address - Phone:845-632-2939
Practice Address - Fax:845-632-2940
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400718-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health