Provider Demographics
NPI:1770194466
Name:SANTANA, ABRAHAM D
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:D
Last Name:SANTANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8114 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3789
Mailing Address - Country:US
Mailing Address - Phone:718-899-9810
Mailing Address - Fax:718-899-9699
Practice Address - Street 1:4308 52ND ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3256
Practice Address - Country:US
Practice Address - Phone:718-458-4243
Practice Address - Fax:718-458-4481
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program