Provider Demographics
NPI:1194761064
Name:SANTANTONIO, DIANA SUSAN (EDS)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:SUSAN
Last Name:SANTANTONIO
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11209 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:OH
Mailing Address - Zip Code:44044-9774
Mailing Address - Country:US
Mailing Address - Phone:440-323-5121
Mailing Address - Fax:440-323-5134
Practice Address - Street 1:750 S ABBE RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7246
Practice Address - Country:US
Practice Address - Phone:440-323-5121
Practice Address - Fax:440-323-5134
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0824657Medicaid
OHCP17262Medicare PIN