Provider Demographics
NPI:1407562358
Name:SANTANA, FATIMA P (LMSW)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:P
Last Name:SANTANA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 BRADY AVE APT 521
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2739
Mailing Address - Country:US
Mailing Address - Phone:732-896-0926
Mailing Address - Fax:
Practice Address - Street 1:2750 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2210
Practice Address - Country:US
Practice Address - Phone:732-896-0926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077022104100000X
NY21225971041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool