Healthcare Provider Details

I. General information

NPI: 1619775558
Provider Name (Legal Business Name): MARIAH LYNN SANTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 QUEEN ST # 1118
SOUTHINGTON CT
06489-1540
US

IV. Provider business mailing address

672 QUEEN ST # 1118
SOUTHINGTON CT
06489-1540
US

V. Phone/Fax

Practice location:
  • Phone: 203-441-5651
  • Fax:
Mailing address:
  • Phone: 860-919-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3962
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: