Provider Demographics
NPI:1093313454
Name:SANTISO, KRISTINE E (LSW)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:E
Last Name:SANTISO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 ASH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-1506
Mailing Address - Country:US
Mailing Address - Phone:814-594-2662
Mailing Address - Fax:
Practice Address - Street 1:20 N MICHAEL ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-1394
Practice Address - Country:US
Practice Address - Phone:814-303-2973
Practice Address - Fax:814-343-1932
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137266104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker