Provider Demographics
NPI:1679275713
Name:SANTANA-SANTILLAN, JOHANCY MARCIAL
Entity Type:Individual
Prefix:
First Name:JOHANCY
Middle Name:MARCIAL
Last Name:SANTANA-SANTILLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 HARBOR ST APT 1/2
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5049
Mailing Address - Country:US
Mailing Address - Phone:978-304-6252
Mailing Address - Fax:
Practice Address - Street 1:35 CONGRESS ST STE 214
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-7312
Practice Address - Country:US
Practice Address - Phone:244-097-8745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health