Provider Demographics
NPI:1649905621
Name:SANTORO, JESSICA (MA, AMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SANTORO
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N CURSON AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6419
Mailing Address - Country:US
Mailing Address - Phone:970-471-0663
Mailing Address - Fax:
Practice Address - Street 1:1000 N CURSON AVE APT 12
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6419
Practice Address - Country:US
Practice Address - Phone:970-471-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142669106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist