Provider Demographics
NPI:1215548136
Name:CRICCHIO, SANTO PRESTI (LMSW)
Entity Type:Individual
Prefix:
First Name:SANTO
Middle Name:PRESTI
Last Name:CRICCHIO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 SUWANEE DAM RD STE 720
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8708
Mailing Address - Country:US
Mailing Address - Phone:678-993-8494
Mailing Address - Fax:678-804-1834
Practice Address - Street 1:4411 SUWANEE DAM RD STE 720
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8708
Practice Address - Country:US
Practice Address - Phone:678-993-8494
Practice Address - Fax:678-804-1834
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0093571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical