Provider Demographics
NPI:1366838195
Name:SANTANA, EMMANUEL (LCSW 79744)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:SANTANA
Suffix:
Gender:M
Credentials:LCSW 79744
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S MAIN ST PH 224
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-2052
Mailing Address - Country:US
Mailing Address - Phone:510-847-5276
Mailing Address - Fax:
Practice Address - Street 1:1900 E SLAUSON AVE STE B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2725
Practice Address - Country:US
Practice Address - Phone:323-277-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA797441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical