Provider Demographics
NPI:1770397630
Name:SANTOS, KRISTY MARIA (LSW)
Entity type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:MARIA
Last Name:SANTOS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2688
Mailing Address - Country:US
Mailing Address - Phone:862-223-9576
Mailing Address - Fax:
Practice Address - Street 1:1200 ROUTE 46 STE 210
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2452
Practice Address - Country:US
Practice Address - Phone:845-507-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07216600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker