Provider Demographics
NPI:1669508255
Name:SANTANA, LOUISE CAROL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:CAROL
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 1:221 BROADWAY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2747
Mailing Address - Country:US
Mailing Address - Phone:631-264-0834
Mailing Address - Fax:631-789-8571
Practice Address - Street 1:221 BROADWAY
Practice Address - Street 2:SUITE 303
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2747
Practice Address - Country:US
Practice Address - Phone:631-264-0834
Practice Address - Fax:631-789-8571
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03231311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPSD1592OtherOXFORD HEALTH
NY147496OtherVALUE OPTIONS
NY01574616Medicaid
NYPSD1592OtherOXFORD HEALTH