1104377662 NPI number — MS. ELIZABETH SANTOS BS, LADC, CADC,

Table of content: MS. ELIZABETH SANTOS BS, LADC, CADC, (NPI 1104377662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104377662 NPI number — MS. ELIZABETH SANTOS BS, LADC, CADC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTOS
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BS, LADC, CADC,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OTERO
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BS, LADC, CADC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104377662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 BEVERLY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIAN ORCHARD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01151-1982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-372-5697
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 BEVERLY LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIAN ORCHARD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01151-1882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-372-5697
Provider Business Practice Location Address Fax Number:
413-739-1430
Provider Enumeration Date:
10/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1411 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com