Provider Demographics
NPI:1548343114
Name:DESANTIS, CLAIRE L (MED, CAP, DABFC)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:L
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:MED, CAP, DABFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-5572
Mailing Address - Country:US
Mailing Address - Phone:941-497-5522
Mailing Address - Fax:941-497-5556
Practice Address - Street 1:153 CENTER RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5572
Practice Address - Country:US
Practice Address - Phone:941-497-5522
Practice Address - Fax:941-497-5556
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP2737101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)