Basic Information
Provider Information | |||||||||
NPI: | 1740327634 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DO SANTOS | ||||||||
FirstName: | GRACIELA | ||||||||
MiddleName: | BEATRIZ | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | L.M.S.W. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 17004 HIGHLAND AVE | ||||||||
Address2: |   | ||||||||
City: | JAMAICA | ||||||||
State: | NY | ||||||||
PostalCode: | 114322745 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7185234109 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 8956 162ND ST | ||||||||
Address2: |   | ||||||||
City: | JAMAICA | ||||||||
State: | NY | ||||||||
PostalCode: | 114325072 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7186577100 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/31/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P53581 | NY | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.