Provider Demographics
NPI:1134999550
Name:SANTIAGO-DIAZ, ERICKA N (LSW, LAMFT, EDD)
Entity type:Individual
Prefix:DR
First Name:ERICKA
Middle Name:N
Last Name:SANTIAGO-DIAZ
Suffix:
Gender:F
Credentials:LSW, LAMFT, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07754-0414
Mailing Address - Country:US
Mailing Address - Phone:787-410-9084
Mailing Address - Fax:
Practice Address - Street 1:635 TIMBER RIDGE CT
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:787-410-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00029200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist