Healthcare Provider Details

I. General information

NPI: 1316363229
Provider Name (Legal Business Name): MS. ELODIE SANTORO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2014
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 N FEDERAL HWY STE 270
BOCA RATON FL
33487-4910
US

IV. Provider business mailing address

911 E ATLANTIC BLVD
POMPANO BEACH FL
33060-7372
US

V. Phone/Fax

Practice location:
  • Phone: 954-376-2869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: