1477831204 NPI number — KRIS SANTAMARIA, LCSW

Table of content: (NPI 1477831204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477831204 NPI number — KRIS SANTAMARIA, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KRIS SANTAMARIA, LCSW
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477831204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 SNOWDEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22901-1297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-249-1304
Provider Business Mailing Address Fax Number:
434-961-2556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 WINDING RIVER LN
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22911-3568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-249-1304
Provider Business Practice Location Address Fax Number:
434-961-2556
Provider Enumeration Date:
07/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SANTAMARIA
Authorized Official First Name:
KRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CLINICIAN
Authorized Official Telephone Number:
434-249-1304

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904004448 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1821193384 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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