Provider Demographics
NPI:1164781720
Name:JEREMY SANTACROCE, RN/NP, LICSW, LLC
Entity Type:Organization
Organization Name:JEREMY SANTACROCE, RN/NP, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTACROCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN/NP, LICSW
Authorized Official - Phone:978-443-6960
Mailing Address - Street 1:323 BOSTON POST RD
Mailing Address - Street 2:UNIT 4C
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3022
Mailing Address - Country:US
Mailing Address - Phone:978-443-6960
Mailing Address - Fax:978-443-6502
Practice Address - Street 1:323 BOSTON POST RD
Practice Address - Street 2:UNIT 4C
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3022
Practice Address - Country:US
Practice Address - Phone:978-443-6960
Practice Address - Fax:978-443-6502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1142291041C0700X
MARN2264377163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty