Provider Demographics
NPI:1316277247
Name:SANTANA, THERESA B
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:B
Last Name:SANTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 DAWN LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-5715
Mailing Address - Country:US
Mailing Address - Phone:856-904-4949
Mailing Address - Fax:
Practice Address - Street 1:827 DAWN LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-5715
Practice Address - Country:US
Practice Address - Phone:856-904-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-26
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst