Provider Demographics
NPI:1902940414
Name:ENGELS, CONSTANCE DIANE (MSSW)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:DIANE
Last Name:ENGELS
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 SPRINGMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-4327
Mailing Address - Country:US
Mailing Address - Phone:214-373-0966
Mailing Address - Fax:214-373-0964
Practice Address - Street 1:7557 RAMBLER RD
Practice Address - Street 2:SUITE 802
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4142
Practice Address - Country:US
Practice Address - Phone:214-750-8488
Practice Address - Fax:214-373-0964
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX046931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S51QMedicare ID - Type UnspecifiedNON PARTICIPATING