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General NPI Number Information
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NPI Number | 1972161644
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Entity Type | Individual
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Provider Name | ANDY MONTAN SANTOS LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 530 N MAIN ST
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City | PROVIDENCE
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State | RI
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Zip | 02904-5762
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Country | US
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Telephone | 401-276-6156
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Fax |
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Provider Business Mailing Address
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Address Line | 279 DODGE ST
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City | WARWICK
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State | RI
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Zip | 02886-1909
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Country | US
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Telephone | 401-678-9532
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | CSW02366
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License Number State | RI
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