Provider Demographics
NPI:1235440199
Name:SANTANIELLO, ELLEN LYDIA (LMHC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:LYDIA
Last Name:SANTANIELLO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAYFLOWER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3521
Mailing Address - Country:US
Mailing Address - Phone:401-316-3226
Mailing Address - Fax:401-331-5772
Practice Address - Street 1:11 MAYFLOWER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3521
Practice Address - Country:US
Practice Address - Phone:401-316-3226
Practice Address - Fax:401-331-5772
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIES92870Medicaid