Healthcare Provider Details

I. General information

NPI: 1740770221
Provider Name (Legal Business Name): FLAVIA R SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 WAVERLEY ST
FRAMINGHAM MA
01702-7079
US

IV. Provider business mailing address

15 LAKE ST
BELLINGHAM MA
02019-2105
US

V. Phone/Fax

Practice location:
  • Phone: 508-270-5700
  • Fax:
Mailing address:
  • Phone: 508-424-8538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number228188
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: