Provider Demographics
NPI:1326118431
Name:SANTANA, MERCEDES (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:MERCEDES
Middle Name:
Last Name:SANTANA
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:PO BOX 849186
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33084-1186
Mailing Address - Country:US
Mailing Address - Phone:954-806-4239
Mailing Address - Fax:954-442-7893
Practice Address - Street 1:701 N HIATUS RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4034
Practice Address - Country:US
Practice Address - Phone:954-806-4239
Practice Address - Fax:954-432-0775
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00037251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6190Medicare ID - Type UnspecifiedLCSW-PSYCHOTHERAPY