Provider Demographics
NPI:1912572215
Name:SANTHOSH, ALEENA
Entity Type:Individual
Prefix:
First Name:ALEENA
Middle Name:
Last Name:SANTHOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 WILLARD AVE APT A2
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2359
Mailing Address - Country:US
Mailing Address - Phone:860-920-8431
Mailing Address - Fax:
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2539
Practice Address - Country:US
Practice Address - Phone:860-800-4758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker