Provider Demographics
NPI:1629318753
Name:SANTIAGO, JACKELIN NOEMI (LCSW, SSW)
Entity Type:Individual
Prefix:MS
First Name:JACKELIN
Middle Name:NOEMI
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LCSW, SSW
Other - Prefix:MS
Other - First Name:JACKY
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, SSW
Mailing Address - Street 1:843 RAHWAY AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3648
Mailing Address - Country:US
Mailing Address - Phone:732-362-6987
Mailing Address - Fax:
Practice Address - Street 1:843 RAHWAY AVE
Practice Address - Street 2:SECOND FLLOR
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3648
Practice Address - Country:US
Practice Address - Phone:732-362-6987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055795001041C0700X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool