Healthcare Provider Details

I. General information

NPI: 1316209687
Provider Name (Legal Business Name): YOHANNY GISELLE SANTANA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 STRATTON RD
RUTLAND VT
05701-4621
US

IV. Provider business mailing address

2021 GRAND CONCOURSE
BRONX NY
10453-4304
US

V. Phone/Fax

Practice location:
  • Phone: 800-468-9118
  • Fax:
Mailing address:
  • Phone: 718-960-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number092426
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0134198
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number086870-01
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW15787
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: