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General NPI Number Information
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NPI Number | 1407282387
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Entity Type | Individual
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Provider Name | JUAN CARLOS SANTANA MA
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Gender | Male
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Dates
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Enumeration Date | 09/23/2013
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Last Update Date | 06/10/2016
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Provider Practice Location Address
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Address Line | 2155 MAIN ST
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City | SPRINGFIELD
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State | MA
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Zip | 01104-3301
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Country | US
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Telephone | 413-736-0395
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Fax | 413-734-1651
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Provider Business Mailing Address
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Address Line | 147 NORMAN ST
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-5003
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Country | US
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Telephone | 413-736-8329
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Fax | 413-732-5362
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 3680
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3680
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License Number State | PR
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