Provider Demographics
NPI:1306076732
Name:SANTOS, JOE ANTHONY (ACSW,LCSW,DCSW,BCD)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:ANTHONY
Last Name:SANTOS
Suffix:
Gender:M
Credentials:ACSW,LCSW,DCSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 SUNFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5530
Mailing Address - Country:US
Mailing Address - Phone:520-452-1436
Mailing Address - Fax:520-452-1447
Practice Address - Street 1:77 CALLE PORTAL STE C240
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2986
Practice Address - Country:US
Practice Address - Phone:520-452-1436
Practice Address - Fax:520-452-1447
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011031041C0700X
AZSW 203311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ751843Medicaid