Provider Demographics
NPI:1992252282
Name:SAN NICOLAS, AARON
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:SAN NICOLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9729 KNOWLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5501
Mailing Address - Country:US
Mailing Address - Phone:808-469-1859
Mailing Address - Fax:
Practice Address - Street 1:9729 KNOWLEDGE DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-5501
Practice Address - Country:US
Practice Address - Phone:808-469-1859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119564106H00000X
MDLCM887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist