Provider Demographics
NPI:1538489620
Name:SANTOS, EGLYS (LMSW)
Entity Type:Individual
Prefix:MS
First Name:EGLYS
Middle Name:
Last Name:SANTOS
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 1:1121 WOODYCREST AVE APT 2G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-4437
Mailing Address - Country:US
Mailing Address - Phone:646-241-4392
Mailing Address - Fax:
Practice Address - Street 1:2780 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4029
Practice Address - Country:US
Practice Address - Phone:718-664-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY083701-1104100000X
NY0846911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker