Provider Demographics
NPI:1316068521
Name:DE LOS SANTOS, MONICA (MS SCHOOL COUNSELOR)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:DE LOS SANTOS
Suffix:
Gender:F
Credentials:MS SCHOOL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1313
Mailing Address - Country:US
Mailing Address - Phone:860-223-2778
Mailing Address - Fax:860-223-3297
Practice Address - Street 1:26 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1313
Practice Address - Country:US
Practice Address - Phone:860-223-2778
Practice Address - Fax:860-223-3297
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT068101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool