Provider Demographics
NPI:1053494336
Name:SANTIAGO, JOSEPH ANTHONY JR (LMHC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:SANTIAGO
Suffix:JR
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 SEIGEL RD
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-5724
Mailing Address - Country:US
Mailing Address - Phone:718-760-8589
Mailing Address - Fax:718-665-1174
Practice Address - Street 1:6227 108TH STREET APT# 11J
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-760-8589
Practice Address - Fax:718-665-1174
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000055-01101YM0800X
NY0000551103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist