Provider Demographics
NPI:1679301204
Name:SANTAMORE NICOLE LLC
Entity type:Organization
Organization Name:SANTAMORE NICOLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTAMORE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:321-408-6393
Mailing Address - Street 1:3061 DAGGET AVE SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-8113
Mailing Address - Country:US
Mailing Address - Phone:207-206-2743
Mailing Address - Fax:
Practice Address - Street 1:2226 SARNO RD STE 100
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3087
Practice Address - Country:US
Practice Address - Phone:321-408-6393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty