Provider Demographics
NPI:1982044590
Name:SANTAELLA, JORGE M (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:M
Last Name:SANTAELLA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 GATTIS DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5409
Mailing Address - Country:US
Mailing Address - Phone:773-218-9651
Mailing Address - Fax:
Practice Address - Street 1:1613 GATTIS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825
Practice Address - Country:US
Practice Address - Phone:773-218-9651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010954101YM0800X, 101YP2500X
FLMH16047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional