Provider Demographics
NPI:1235819848
Name:SANTOS, ELISON SILVA (MS)
Entity Type:Individual
Prefix:MR
First Name:ELISON
Middle Name:SILVA
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WASHINGTON CIRCLE NW
Mailing Address - Street 2:SUITE 406
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-309-2048
Mailing Address - Fax:
Practice Address - Street 1:3 WASHINGTON CIRCLE NW
Practice Address - Street 2:SUITE 406
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-309-2048
Practice Address - Fax:202-600-9401
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSYA200001359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical