Provider Demographics
NPI:1477831204
Name:KRIS SANTAMARIA, LCSW
Entity type:Organization
Organization Name:KRIS SANTAMARIA, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTAMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:434-249-1304
Mailing Address - Street 1:1120 SNOWDEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1297
Mailing Address - Country:US
Mailing Address - Phone:434-249-1304
Mailing Address - Fax:434-961-2556
Practice Address - Street 1:315 WINDING RIVER LN
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3568
Practice Address - Country:US
Practice Address - Phone:434-249-1304
Practice Address - Fax:434-961-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040044481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821193384OtherINDIVIDUAL NPI