Provider Demographics
NPI:1346537818
Name:AGUIRRE, SANTIAGO L (MS,LPC)
Entity Type:Individual
Prefix:MR
First Name:SANTIAGO
Middle Name:L
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 ALBRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-3064
Mailing Address - Country:US
Mailing Address - Phone:203-386-0357
Mailing Address - Fax:
Practice Address - Street 1:518 MONROE TPKE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2358
Practice Address - Country:US
Practice Address - Phone:203-258-6326
Practice Address - Fax:203-452-0405
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional