MEDICARE: LAUREN SANTOS

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	106H00000X	Marriage & Family Therapist
2	106H00000X	Marriage & Family Therapist		PA
3	106H00000X	Marriage & Family Therapist	MF000654	PA

General Provider Information

NPI Number	:	1881945202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN SANTOS

Provider Business Mailing Address
First Line	:	6622 N AMERICAN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-3114
Country	:	US
Telephone Number	:	215-850-8323
Fax Number	:

Provider Business Practice Location Address
First Line	:	2938 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2801
Country	:	US
Telephone Number	:	267-909-8550
Fax Number	:

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

Provider Enumeration Date	:	09/25/2012
Last Update Date	:	12/03/2012

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Directions to “ LAUREN SANTOS ” Practice Location

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