Healthcare Provider Details

I. General information

NPI: 1194265769
Provider Name (Legal Business Name): BETSY A SANTANA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 AMERICAN LEGION HWY
ROSLINDALE MA
02131
US

IV. Provider business mailing address

780 AMERICAN LEGION HWY
ROSLINDALE MA
02131-3908
US

V. Phone/Fax

Practice location:
  • Phone: 617-469-8505
  • Fax: 617-469-8595
Mailing address:
  • Phone: 617-469-8505
  • Fax: 617-469-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000223692
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: