Provider Demographics
NPI:1932651551
Name:JANET SANTIAGO, LCSW
Entity Type:Organization
Organization Name:JANET SANTIAGO, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:772-626-2321
Mailing Address - Street 1:1102 SW IDOL AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6816
Mailing Address - Country:US
Mailing Address - Phone:772-626-2321
Mailing Address - Fax:772-800-3175
Practice Address - Street 1:759 SW FEDERAL HWY
Practice Address - Street 2:SUITE 304
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2914
Practice Address - Country:US
Practice Address - Phone:772-626-2321
Practice Address - Fax:772-800-3175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW109971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018536200Medicaid