Provider Demographics
NPI:1053147181
Name:SANTANA, CARLOS ADAM (MS, CAC, LADC)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ADAM
Last Name:SANTANA
Suffix:
Gender:M
Credentials:MS, CAC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 TOWNSEND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-4503
Mailing Address - Country:US
Mailing Address - Phone:203-907-9235
Mailing Address - Fax:
Practice Address - Street 1:690 ARCTIC ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06608-2008
Practice Address - Country:US
Practice Address - Phone:203-339-4112
Practice Address - Fax:203-339-4112
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT44.001579101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty