Healthcare Provider Details

I. General information

NPI: 1902428733
Provider Name (Legal Business Name): MIRIAM SANTOSCOY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FENWAY LN
HANSCOM AFB MA
01731-2665
US

IV. Provider business mailing address

15 FENWAY LN
HANSCOM AFB MA
01731-2665
US

V. Phone/Fax

Practice location:
  • Phone: 951-733-3953
  • Fax:
Mailing address:
  • Phone: 951-733-3953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1144222
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: