Provider Demographics
NPI:1891101481
Name:SANTORO, NICOLINA MARIE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:NICOLINA
Middle Name:MARIE
Last Name:SANTORO
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:NICOLINA
Other - Middle Name:
Other - Last Name:CAHOUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 2142
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-8142
Mailing Address - Country:US
Mailing Address - Phone:916-613-6048
Mailing Address - Fax:
Practice Address - Street 1:5330 PRIMROSE DR STE 240
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3542
Practice Address - Country:US
Practice Address - Phone:916-613-6048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106682106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist