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General NPI Number Information
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NPI Number | 1003353616
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Entity Type | Individual
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Provider Name | NICOLE SANTOS
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Gender | Female
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Dates
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Enumeration Date | 01/21/2017
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Last Update Date | 01/21/2017
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Provider Practice Location Address
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Address Line | 433 WEST ST SUITE 5
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City | AMHERST
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State | MA
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Zip | 01002-2936
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Country | US
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Telephone | 413-687-3520
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Fax |
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Provider Business Mailing Address
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Address Line | 591 MOORE ST
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City | LUDLOW
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State | MA
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Zip | 01056-1607
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Country | US
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Telephone | 413-626-8084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9947
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2081
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License Number State | CT
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