Provider Demographics
NPI:1487794756
Name:SERIO, CONSTANCE NICOLE (EDS, NCSP)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:NICOLE
Last Name:SERIO
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 W GUADALUPE RD
Mailing Address - Street 2:APT. 1123
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3005
Mailing Address - Country:US
Mailing Address - Phone:602-690-1021
Mailing Address - Fax:
Practice Address - Street 1:1030 N BLUE GROTTO DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4905
Practice Address - Country:US
Practice Address - Phone:480-926-6301
Practice Address - Fax:480-813-9011
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ884173Medicaid