Provider Demographics
NPI:1164558573
Name:SANTOS, MARIA ELENA (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ELENA
Last Name:SANTOS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1704
Mailing Address - Country:US
Mailing Address - Phone:315-735-2236
Mailing Address - Fax:315-735-9177
Practice Address - Street 1:401 COLUMBIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3413
Practice Address - Country:US
Practice Address - Phone:315-735-2236
Practice Address - Fax:315-735-9177
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043329-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR043329-1OtherLICENSED CLINICAL SOCIAL