Provider Demographics
NPI:1962245621
Name:DE LOS SANTOS, JORDDANA (MFT)
Entity type:Individual
Prefix:
First Name:JORDDANA
Middle Name:
Last Name:DE LOS SANTOS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-2351
Mailing Address - Country:US
Mailing Address - Phone:516-451-9936
Mailing Address - Fax:
Practice Address - Street 1:243 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5532
Practice Address - Country:US
Practice Address - Phone:516-387-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist