Basic Information
| Provider Information | |||||||||
| NPI: | 1740770221 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTOS | ||||||||
| FirstName: | FLAVIA | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 LAKE ST | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020192105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084248538 | ||||||||
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| Practice Location | |||||||||
| Address1: | 354 WAVERLEY ST | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017027079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082705700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2018 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 228188 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.