Provider Demographics
NPI:1114220977
Name:SANTIAGO, RICHARD (LMSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CARPENTER PL
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3515
Mailing Address - Country:US
Mailing Address - Phone:845-782-0295
Mailing Address - Fax:
Practice Address - Street 1:101 CARPENTER PL
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3515
Practice Address - Country:US
Practice Address - Phone:845-782-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070330101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)