# LIFESPAN WELLNESS MARRIAGE & FAMILY THERAPY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982185161
- **Authorized official:** MS. MARIA CONSTANTINOU LMFT (DIRECTOR)
- **Authorized official phone:** (917) 913-6441

## Contact information

- **Practice address:** 21333 39TH AVE STE 235, BAYSIDE, NY 11361-2174
- **Practice address phone:** (917) 913-6441
- **Mailing address:** 2608 BAYSIDE LN, FLUSHING, NY 11358-1054

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | 001372 | NY | Yes |

## Other

- **Enumeration date:** 08/24/2018
- **Last updated:** 11/30/2018