Provider Demographics
NPI:1912941352
Name:SANTORO, ANTHONY V SR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:V
Last Name:SANTORO
Suffix:SR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16108 E EMERALD DR UNIT 204S
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-5424
Mailing Address - Country:US
Mailing Address - Phone:516-978-8294
Mailing Address - Fax:
Practice Address - Street 1:16108 E EMERALD DR UNIT 204S
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-5424
Practice Address - Country:US
Practice Address - Phone:516-978-8294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005546103T00000X
NY013294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01824111Medicaid