Provider Demographics
NPI:1851447981
Name:SANTANA, MARIA IVETTE (LICSW, LADC I, MPGS)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:IVETTE
Last Name:SANTANA
Suffix:
Gender:F
Credentials:LICSW, LADC I, MPGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BASIL RD
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4938
Mailing Address - Country:US
Mailing Address - Phone:141-388-5396
Mailing Address - Fax:413-331-0082
Practice Address - Street 1:17 BASIL RD
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-4938
Practice Address - Country:US
Practice Address - Phone:413-885-3965
Practice Address - Fax:413-331-0082
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1620101Y00000X
MA1182621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor