Healthcare Provider Details

I. General information

NPI: 1447515010
Provider Name (Legal Business Name): SHANNON SANTORO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MAPLE AVE
RIDGEWOOD NJ
07450-3233
US

IV. Provider business mailing address

101 SILVER FOX TRL
STOCKHOLM NJ
07460-1233
US

V. Phone/Fax

Practice location:
  • Phone: 973-271-8940
  • Fax:
Mailing address:
  • Phone: 973-271-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHANNON SANTORO
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential:
Phone: 973-271-8940