Provider Demographics
NPI:1174923387
Name:DESANTIS, LAURA (MPHILED)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:MPHILED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 MONTGOMERY STREET, STE 490
Mailing Address - Street 2:DPT#17076
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111
Mailing Address - Country:US
Mailing Address - Phone:415-935-0947
Mailing Address - Fax:
Practice Address - Street 1:655 MONTGOMERY STREET, STE 490
Practice Address - Street 2:DPT#17076
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111
Practice Address - Country:US
Practice Address - Phone:415-376-7385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCC5453101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional