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General NPI Number Information
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NPI Number | 1003541392
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Entity Type | Individual
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Provider Name | CARLOS SANTANA LMSW
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Gender | Male
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 560 SOUTHERN BLVD
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City | BRONX
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State | NY
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Zip | 10455-3715
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Country | US
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Telephone | 718-542-8082
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Fax |
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Provider Business Mailing Address
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Address Line | 2513 86TH ST
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City | EAST ELMHURST
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State | NY
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Zip | 11369-1026
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Country | US
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Telephone | 646-204-6422
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 115764-01
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License Number State | NY
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