Provider Demographics
NPI:1972926467
Name:DE LOS SANTOS, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DE LOS SANTOS
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 1:561 ACADEMY ST
Mailing Address - Street 2:52
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-5143
Mailing Address - Country:US
Mailing Address - Phone:646-531-4147
Mailing Address - Fax:
Practice Address - Street 1:364 E 151ST ST
Practice Address - Street 2:BASEMAN
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-2603
Practice Address - Country:US
Practice Address - Phone:646-531-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical