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General NPI Number Information
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NPI Number | 1316336720
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Entity Type | Organization
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Legal Business Name | NANCY A SANTORO PSYD LLC
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 4 MILITIA DR SUITE 23
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City | LEXINGTON
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State | MA
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Zip | 02421-4737
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Country | US
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Telephone | 978-831-7701
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Fax | 978-252-7475
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Provider Business Mailing Address
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Address Line | 4 MILITIA DR SUITE 23
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City | LEXINGTON
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State | MA
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Zip | 02421-4737
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Country | US
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Telephone | 978-831-7701
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Fax | 978-252-7475
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | NANCY SANTORO
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Credential |
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Telephone | 978-831-7701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8673
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License Number State | MA
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