Provider Demographics
NPI:1215152632
Name:SANTACROCE, JEREMY P (RN/NP, LICSW)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:P
Last Name:SANTACROCE
Suffix:
Gender:M
Credentials:RN/NP, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:323 BOSTON POST RD
Mailing Address - Street 2:UNIT 4C
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3022
Mailing Address - Country:US
Mailing Address - Phone:978-443-6960
Mailing Address - Fax:978-443-6502
Practice Address - Street 1:323 BOSTON POST RD
Practice Address - Street 2:UNIT 4C
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3022
Practice Address - Country:US
Practice Address - Phone:978-443-6960
Practice Address - Fax:978-443-6502
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA213256104100000X
MA1142291041C0700X
MARN2264377163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse