MEDICARE: CAROL SANTUCCI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC303300	DC
2	1041C0700X	Clinical Social Worker	10513	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2129984	OTHER	DC	MAMSI
2	355807	OTHER	DC	MHN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	K0400001	OTHER	DC	CAREFIRST BCBS
5	7260639	OTHER	DC	AETNA

General Provider Information

NPI Number	:	1134220874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL SANTUCCI

Provider Business Mailing Address
First Line	:	3900 TUNLAW RD NW
Second Line	:	# 301
City	:	WASHINGTON
State	:	DC
Zip	:	20007-4807
Country	:	US
Telephone Number	:	202-248-8828
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 17TH ST NW
Second Line	:	SUITE 1000
City	:	WASHINGTON
State	:	DC
Zip	:	20036-5512
Country	:	US
Telephone Number	:	202-255-5889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	05/05/2008

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Directions to “ CAROL SANTUCCI ” Practice Location

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