Provider Demographics
NPI:1679996193
Name:SANTOS, NATASCHA M (PSY D)
Entity Type:Individual
Prefix:DR
First Name:NATASCHA
Middle Name:M
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 DEER PARK AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2119
Mailing Address - Country:US
Mailing Address - Phone:631-865-5463
Mailing Address - Fax:
Practice Address - Street 1:2100 DEER PARK AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2119
Practice Address - Country:US
Practice Address - Phone:631-865-5463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020449-1103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral