Provider Demographics
NPI:1922231372
Name:SANTUCCI, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:SANTUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THERESEA
Other - Middle Name:
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:106 E CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT ROYAL
Mailing Address - State:NJ
Mailing Address - Zip Code:08061-1143
Mailing Address - Country:US
Mailing Address - Phone:856-746-4244
Mailing Address - Fax:609-272-8707
Practice Address - Street 1:106 E CROSSING DR
Practice Address - Street 2:
Practice Address - City:MOUNT ROYAL
Practice Address - State:NJ
Practice Address - Zip Code:08061-1143
Practice Address - Country:US
Practice Address - Phone:856-746-4244
Practice Address - Fax:609-272-8707
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05348900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health