Provider Demographics
NPI:1184106064
Name:SANTOS, ERIBERTO (LADC, CAC, NOTARY)
Entity type:Individual
Prefix:MR
First Name:ERIBERTO
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:LADC, CAC, NOTARY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06601-0462
Mailing Address - Country:US
Mailing Address - Phone:203-450-9322
Mailing Address - Fax:
Practice Address - Street 1:139 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3619
Practice Address - Country:US
Practice Address - Phone:203-450-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1424101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5956OtherCONNECTICUT CERTIFICATIONS BOARD
CT1424OtherCONNECTICUT DEPARTMENT OF PUBLIC HEALTH