Provider Demographics
NPI:1841702313
Name:SANTANA, EDWARD (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:SANTANA
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CHANNEL ST APT 705
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-1735
Mailing Address - Country:US
Mailing Address - Phone:310-204-1500
Mailing Address - Fax:310-204-1500
Practice Address - Street 1:185 CHANNEL ST APT 435
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-1722
Practice Address - Country:US
Practice Address - Phone:310-204-1500
Practice Address - Fax:310-204-1500
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist