Provider Demographics
NPI:1538500442
Name:MEDINA-SANTIAGO, DELIA JEANETTE (SPECIAL ED, MS)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:JEANETTE
Last Name:MEDINA-SANTIAGO
Suffix:
Gender:F
Credentials:SPECIAL ED, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W 251ST ST
Mailing Address - Street 2:APT 6A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3042
Mailing Address - Country:US
Mailing Address - Phone:646-714-8453
Mailing Address - Fax:
Practice Address - Street 1:210 W 251ST ST
Practice Address - Street 2:APT 6A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3042
Practice Address - Country:US
Practice Address - Phone:646-714-8453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY731635131103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst