MEDICARE: MS. IRIS GRISELDA SANTOS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053875104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRIS GRISELDA SANTOS LCSW

Provider Business Mailing Address
First Line	:	6249 EDGEWATER DR # 1058
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-4739
Country	:	US
Telephone Number	:	689-231-1235
Fax Number	:	877-388-0384

Provider Business Practice Location Address
First Line	:	6249 EDGEWATER DR # 1058
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-4739
Country	:	US
Telephone Number	:	321-438-5826
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	12/27/2022

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