Healthcare Provider Details

I. General information

NPI: 1477983567
Provider Name (Legal Business Name): CHARLES SANTORO LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 W ONONDAGA ST
SYRACUSE NY
13202-1888
US

IV. Provider business mailing address

375 W ONONDAGA ST
SYRACUSE NY
13202-1888
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-2030
  • Fax: 315-478-2250
Mailing address:
  • Phone: 315-478-2030
  • Fax: 315-478-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number089083-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: