Provider Demographics
NPI:1043674427
Name:SANTO, LUCRETIA NICOLE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:LUCRETIA
Middle Name:NICOLE
Last Name:SANTO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 E 14TH ST
Mailing Address - Street 2:APT 7H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:651 E 14TH ST
Practice Address - Street 2:APT 7H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3119
Practice Address - Country:US
Practice Address - Phone:201-739-7683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist