Provider Demographics
NPI:1508171828
Name:SANTASIERI, PAUL MICHAEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MICHAEL
Last Name:SANTASIERI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 NEPTUNE DR
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-1748
Mailing Address - Country:US
Mailing Address - Phone:609-713-5662
Mailing Address - Fax:
Practice Address - Street 1:177 NEPTUNE DR
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-1748
Practice Address - Country:US
Practice Address - Phone:609-713-5662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00170300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist