Provider Demographics
NPI:1174000251
Name:SANTANA, JESLEEN
Entity Type:Individual
Prefix:
First Name:JESLEEN
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MORRIS AVE APT 6B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4768
Mailing Address - Country:US
Mailing Address - Phone:917-496-1474
Mailing Address - Fax:
Practice Address - Street 1:601 MORRIS AVE APT 6B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4768
Practice Address - Country:US
Practice Address - Phone:917-496-1474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician