Provider Demographics
NPI:1184001182
Name:SANTIAGO, ANDREA (LCSW, CST)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LCSW, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6541 PELICAN TER
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2425
Mailing Address - Country:US
Mailing Address - Phone:954-303-1529
Mailing Address - Fax:954-827-0452
Practice Address - Street 1:2200 N COMMERCE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3258
Practice Address - Country:US
Practice Address - Phone:954-805-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW122751041C0700X
FLSW 122751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty