Provider Demographics
NPI:1720331002
Name:SANTANA, MERCEDES (PHD)
Entity type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 N INNSBRUCK DR
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5920
Mailing Address - Country:US
Mailing Address - Phone:612-393-3656
Mailing Address - Fax:
Practice Address - Street 1:1440 N INNSBRUCK DR
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5920
Practice Address - Country:US
Practice Address - Phone:612-393-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6414103TC1900X
WI1679-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)