Provider Demographics
NPI:1003677733
Name:SANTIAGO, BRITTANY (LAC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 W 48TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2173
Mailing Address - Country:US
Mailing Address - Phone:551-232-1550
Mailing Address - Fax:
Practice Address - Street 1:258 1ST ST STE 202
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3561
Practice Address - Country:US
Practice Address - Phone:201-279-5034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00741000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health