Provider Demographics
NPI:1598498834
Name:SANTIAGO, LOURDES PATRICIA (LMHC)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:PATRICIA
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12590 PINES BLVD # 260153
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-9998
Mailing Address - Country:US
Mailing Address - Phone:754-259-2238
Mailing Address - Fax:
Practice Address - Street 1:11820 MIRAMAR PKWY SUITE 111
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-1018
Practice Address - Country:US
Practice Address - Phone:754-259-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20923103TP2701X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy