Provider Demographics
NPI:1891063897
Name:COSTANZA, BESSIE NAOMI (LCSW)
Entity type:Individual
Prefix:MS
First Name:BESSIE
Middle Name:NAOMI
Last Name:COSTANZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 HIGHWAY 49 W
Mailing Address - Street 2:
Mailing Address - City:VANLEER
Mailing Address - State:TN
Mailing Address - Zip Code:37181-5036
Mailing Address - Country:US
Mailing Address - Phone:931-980-1584
Mailing Address - Fax:
Practice Address - Street 1:1821 HAYNES ST STE 3
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-980-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical