Provider Demographics
NPI:1912097767
Name:SANTARSIERO, AMY E (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:SANTARSIERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 BRIARWOOD RD
Mailing Address - Street 2:NAUGATUCK
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-1607
Mailing Address - Country:US
Mailing Address - Phone:203-525-6245
Mailing Address - Fax:
Practice Address - Street 1:16 JARVIS STREET
Practice Address - Street 2:CHESHIRE
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1503
Practice Address - Country:US
Practice Address - Phone:203-806-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0053561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800003162Medicare ID - Type Unspecified