Provider Demographics
NPI:1104377662
Name:SANTOS, ELIZABETH (BS, LADC, CADC,)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:BS, LADC, CADC,
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:OTERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, LADC, CADC
Mailing Address - Street 1:70 BEVERLY LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN ORCHARD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1982
Mailing Address - Country:US
Mailing Address - Phone:413-372-5697
Mailing Address - Fax:
Practice Address - Street 1:70 BEVERLY LANE
Practice Address - Street 2:
Practice Address - City:INDIAN ORCHARD
Practice Address - State:MA
Practice Address - Zip Code:01151-1882
Practice Address - Country:US
Practice Address - Phone:413-372-5697
Practice Address - Fax:413-739-1430
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health