Provider Demographics
NPI:1194852517
Name:SANTORO, NANCY (PSYD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SANTORO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MILITIA DRIVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4737
Mailing Address - Country:US
Mailing Address - Phone:978-831-7701
Mailing Address - Fax:
Practice Address - Street 1:4 MILITIA DRIVE
Practice Address - Street 2:SUITE 23
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4737
Practice Address - Country:US
Practice Address - Phone:978-831-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10556OtherBCBS