Provider Demographics
NPI:1134220874
Name:SANTUCCI, CAROL
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SANTUCCI
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 1:3900 TUNLAW RD NW
Mailing Address - Street 2:# 301
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4807
Mailing Address - Country:US
Mailing Address - Phone:202-248-8828
Mailing Address - Fax:
Practice Address - Street 1:1050 17TH ST NW
Practice Address - Street 2:SUITE 1000
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5512
Practice Address - Country:US
Practice Address - Phone:202-255-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3033001041C0700X
MD105131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2129984OtherMAMSI
DC355807OtherMHN
MD406124101Medicaid
DCK0400001OtherCAREFIRST BCBS
DC7260639OtherAETNA
MD406124101Medicaid