Provider Demographics
NPI:1912098575
Name:CA SANTUCCI PLLC
Entity Type:Organization
Organization Name:CA SANTUCCI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:202-248-8828
Mailing Address - Street 1:3900 TUNLAW RD NW
Mailing Address - Street 2:# 301
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4807
Mailing Address - Country:US
Mailing Address - Phone:202-248-8828
Mailing Address - Fax:
Practice Address - Street 1:1050 17TH ST NW
Practice Address - Street 2:SUITE 1000
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5512
Practice Address - Country:US
Practice Address - Phone:202-255-5889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3033001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPTAN G02617Medicare UPIN