Healthcare Provider Details

I. General information

NPI: 1215152632
Provider Name (Legal Business Name): JEREMY P SANTACROCE RN/NP, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 BOSTON POST RD UNIT 4C
SUDBURY MA
01776-3022
US

IV. Provider business mailing address

323 BOSTON POST RD UNIT 4C
SUDBURY MA
01776-3022
US

V. Phone/Fax

Practice location:
  • Phone: 978-443-6960
  • Fax: 978-443-6502
Mailing address:
  • Phone: 978-443-6960
  • Fax: 978-443-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number213256
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114229
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2264377
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2264377
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: