Healthcare Provider Details

I. General information

NPI: 1659946176
Provider Name (Legal Business Name): SANTINA MARITATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date: 07/03/2025
Reactivation Date: 08/09/2025

III. Provider practice location address

98-939 MOANALUA RD
AIEA HI
96701-5012
US

IV. Provider business mailing address

8331 PINE KNOTT CT
GAINESVILLE VA
20155-5218
US

V. Phone/Fax

Practice location:
  • Phone: 855-223-7123
  • Fax:
Mailing address:
  • Phone: 703-505-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC-1138-0
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: