Provider Demographics
NPI:1891734539
Name:SANTORO, VITTORIO SALVATORE (PHD, LCSW-C)
Entity Type:Individual
Prefix:DR
First Name:VITTORIO
Middle Name:SALVATORE
Last Name:SANTORO
Suffix:
Gender:M
Credentials:PHD, LCSW-C
Other - Prefix:DR
Other - First Name:VITTORIO
Other - Middle Name:SALVATORE
Other - Last Name:SANTORO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2607 GLENCOE CIR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1488
Mailing Address - Country:US
Mailing Address - Phone:443-742-5513
Mailing Address - Fax:410-461-5671
Practice Address - Street 1:1110 BENFIELD BLVD
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2540
Practice Address - Country:US
Practice Address - Phone:410-987-3354
Practice Address - Fax:410-987-4710
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD002681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQR43Medicare ID - Type UnspecifiedLCSW-C