Provider Demographics
NPI:1942088026
Name:SANTOS, KAITLYN ROSE (MSW)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ROSE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10935 LOCH LOMOND DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-1533
Mailing Address - Country:US
Mailing Address - Phone:562-646-8125
Mailing Address - Fax:
Practice Address - Street 1:10935 LOCH LOMOND DR
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-1533
Practice Address - Country:US
Practice Address - Phone:562-646-8125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1201211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical