Provider Demographics
NPI:1053611244
Name:KONSTAM, ELISHEVA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELISHEVA
Middle Name:
Last Name:KONSTAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4311
Mailing Address - Country:US
Mailing Address - Phone:347-702-8113
Mailing Address - Fax:
Practice Address - Street 1:1636 COLEMAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4311
Practice Address - Country:US
Practice Address - Phone:347-702-8113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist