Provider Demographics
NPI:1659492072
Name:SANTANA, BLANCA IRIS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:IRIS
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 1:1150 PELHAM PKWY S APT 2G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1010
Mailing Address - Country:US
Mailing Address - Phone:646-765-6349
Mailing Address - Fax:
Practice Address - Street 1:175 W 76TH ST
Practice Address - Street 2:SUITE 2G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-8302
Practice Address - Country:US
Practice Address - Phone:646-765-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR063076-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical