Provider Demographics
NPI:1003017815
Name:SANTIAGO, JAIME (MED, LMHC)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER ST STE 210
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-2870
Mailing Address - Country:US
Mailing Address - Phone:413-273-3736
Mailing Address - Fax:413-961-0893
Practice Address - Street 1:10 CENTER ST STE 210
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-2870
Practice Address - Country:US
Practice Address - Phone:413-273-3736
Practice Address - Fax:413-961-0893
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8229101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health