Provider Demographics
NPI:1376133439
Name:SANTORO, RENEE LOUISE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:LOUISE
Last Name:SANTORO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:LOUISE
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8401 WAYZATA BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1365
Mailing Address - Country:US
Mailing Address - Phone:763-556-0088
Mailing Address - Fax:763-556-0089
Practice Address - Street 1:8401 WAYZATA BLVD STE 340
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1365
Practice Address - Country:US
Practice Address - Phone:763-556-0088
Practice Address - Fax:763-556-0089
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional