Healthcare Provider Details

I. General information

NPI: 1063862092
Provider Name (Legal Business Name): LUZ C SANTANA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BEACH CHANNEL DR
ARVERNE NY
11692-1409
US

IV. Provider business mailing address

321 BEACH 67TH ST
ARVERNE NY
11692-1431
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax: 718-945-1743
Mailing address:
  • Phone: 718-945-3734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number070343
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: