Provider Demographics
NPI:1528580149
Name:SANTIAGO, MELANIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BOERUM ST APT 4S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-2428
Mailing Address - Country:US
Mailing Address - Phone:347-845-3181
Mailing Address - Fax:
Practice Address - Street 1:3646 37TH ST FL 2
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-1606
Practice Address - Country:US
Practice Address - Phone:718-897-7904
Practice Address - Fax:718-786-8616
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100454104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty