Provider Demographics
NPI:1902054489
Name:SANTANA, KATIE JANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:JANE
Last Name:SANTANA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:JANE
Other - Last Name:SOBIECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:121 NEW ST
Mailing Address - Street 2:3C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106
Mailing Address - Country:US
Mailing Address - Phone:267-441-2542
Mailing Address - Fax:
Practice Address - Street 1:2305 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2515
Practice Address - Country:US
Practice Address - Phone:267-441-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
PACW0182201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical