Provider Demographics
NPI:1598050429
Name:SANTIAGO ROMERO, JACQUELINE N/A
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:N/A
Last Name:SANTIAGO ROMERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 UNION ST
Mailing Address - Street 2:SIUTE 557
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1866
Mailing Address - Country:US
Mailing Address - Phone:978-682-7289
Mailing Address - Fax:978-686-2954
Practice Address - Street 1:15 UNION ST
Practice Address - Street 2:SIUTE 557
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1866
Practice Address - Country:US
Practice Address - Phone:978-682-7289
Practice Address - Fax:978-686-2954
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst