Provider Demographics
NPI:1932963725
Name:LIZ SANTANA, GABRIELA B (MS, LMHC-A)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:B
Last Name:LIZ SANTANA
Suffix:
Gender:F
Credentials:MS, LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-3944
Mailing Address - Country:US
Mailing Address - Phone:401-226-3859
Mailing Address - Fax:
Practice Address - Street 1:85 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-3944
Practice Address - Country:US
Practice Address - Phone:401-226-3859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00167-A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health