Provider Demographics
NPI:1891129060
Name:SANTOS, JOSE L (MS ED)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:L
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MS ED
Other - Prefix:PROF
Other - First Name:JOSE
Other - Middle Name:L
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS ED
Mailing Address - Street 1:30 ELLWOOD ST
Mailing Address - Street 2:APT.6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1937
Mailing Address - Country:US
Mailing Address - Phone:347-366-7959
Mailing Address - Fax:
Practice Address - Street 1:7000 AUSTIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1022
Practice Address - Country:US
Practice Address - Phone:718-762-7633
Practice Address - Fax:718-886-8694
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295534103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst