Basic Information
| Provider Information | |||||||||
| NPI: | 1093802308 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTOS | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2977 BAINBRIDGE AVE APT 505 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104582140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182200039 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4123 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104576222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182993045 | ||||||||
| FaxNumber: | 7187162604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 73-054291 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.