Provider Demographics
NPI:1326499823
Name:SANTIAGO, JOANNA SUE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:SUE
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11379 ARISTOTLE DR
Mailing Address - Street 2:APT 409
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0948
Mailing Address - Country:US
Mailing Address - Phone:804-896-5627
Mailing Address - Fax:
Practice Address - Street 1:6420 OLDE BULLOCKS CIR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2923
Practice Address - Country:US
Practice Address - Phone:703-675-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst