Healthcare Provider Details

I. General information

NPI: 1316068521
Provider Name (Legal Business Name): MONICA DE LOS SANTOS MS SCHOOL COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 RUSSELL ST
NEW BRITAIN CT
06052-1313
US

IV. Provider business mailing address

26 RUSSELL ST
NEW BRITAIN CT
06052-1313
US

V. Phone/Fax

Practice location:
  • Phone: 860-223-2778
  • Fax: 860-223-3297
Mailing address:
  • Phone: 860-223-2778
  • Fax: 860-223-3297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number068
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: