Healthcare Provider Details

I. General information

NPI: 1679188312
Provider Name (Legal Business Name): BRIENNA NICOLE SANTANIELLO MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/04/2024
Certification Date: 08/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 OAK ST STE 201
NEWTON MA
02464-1493
US

IV. Provider business mailing address

109 OAK ST STE 201
NEWTON MA
02464-1493
US

V. Phone/Fax

Practice location:
  • Phone: 617-977-5372
  • Fax: 617-458-8644
Mailing address:
  • Phone: 617-977-5372
  • Fax: 617-458-8644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10000857
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: