MEDICARE: DONNA SANTAVICCA LMSW

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	104100000X	Social Worker	109713	NY

General Provider Information

NPI Number	:	1619580347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA SANTAVICCA LMSW

Provider Business Mailing Address
First Line	:	667 STONELEIGH AVE STE 202
Second Line	:
City	:	CARMEL
State	:	NY
Zip	:	10512-2455
Country	:	US
Telephone Number	:	845-279-5908
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 PEARL ST
Second Line	:
City	:	PORT CHESTER
State	:	NY
Zip	:	10573-4611
Country	:	US
Telephone Number	:	914-265-2762
Fax Number	:	914-653-8282

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

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/24/2020

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Directions to “ DONNA SANTAVICCA LMSW” Practice Location

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