Provider Demographics
NPI:1679692701
Name:SANTORO, JENNIFER MATTUCCI (M D)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MATTUCCI
Last Name:SANTORO
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8301 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2902
Mailing Address - Country:US
Mailing Address - Phone:703-207-0001
Mailing Address - Fax:703-573-5429
Practice Address - Street 1:8301 ARLINGTON BLVD
Practice Address - Street 2:SUITE 505
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2902
Practice Address - Country:US
Practice Address - Phone:703-207-0001
Practice Address - Fax:703-573-5429
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012377282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry