Provider Demographics
NPI:1326108028
Name:DESANTIS, DENISE ELAINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ELAINE
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 BERKSHIRE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610
Mailing Address - Country:US
Mailing Address - Phone:610-373-7005
Mailing Address - Fax:610-373-8005
Practice Address - Street 1:1150 BERKSHIRE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610
Practice Address - Country:US
Practice Address - Phone:610-373-7005
Practice Address - Fax:610-373-8005
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0134061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2726603000OtherMAGELLAN
50059755OtherCAP BC