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NPI Code Detail

MEDICARE: MRS. SANDRA ANN SANTAROSSA LMSW

MEDICARE: MRS. SANDRA ANN SANTAROSSA LMSW
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
11041C0700XClinical Social Worker6801066037MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11007731OTHERMIMCLAREN HEALTH ADVANTAGE
20998090OTHERMIHEALTH PLUS
31007731OTHERMIMCLAREN HEALTH PLAN

General Provider Information

NPI Number : 1497852537
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SANDRA ANN SANTAROSSA LMSW
Provider Business Mailing Address
First Line : 2257 ROCK VALLEY RD
Second Line :
City : METAMORA
State : MI
Zip : 48455-9333
Country : US
Telephone Number : 810-667-0500
Fax Number :
Provider Business Practice Location Address
First Line : 1570 SUNCREST DR
Second Line :
City : LAPEER
State : MI
Zip : 48446-1154
Country : US
Telephone Number : 810-667-0500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/08/2007

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