Healthcare Provider Details

I. General information

NPI: 1699692087
Provider Name (Legal Business Name): BRIANNE SANTOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 GOVERNOR CARLOS CAMACHO ROAD
TAMUNING GU
96913
US

IV. Provider business mailing address

115 ETTON CT
SINAJANA GU
96910-3223
US

V. Phone/Fax

Practice location:
  • Phone: 671-747-0135
  • Fax:
Mailing address:
  • Phone: 671-747-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5514
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: