Provider Demographics
NPI:1184064370
Name:SANTIAGO, DONNA T (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:T
Last Name:SANTIAGO
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:T
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:100 W GRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1234
Mailing Address - Country:US
Mailing Address - Phone:575-647-2800
Mailing Address - Fax:575-647-2898
Practice Address - Street 1:1900 E. 10TH STREET
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310
Practice Address - Country:US
Practice Address - Phone:575-434-7404
Practice Address - Fax:575-439-2860
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-08314104100000X
NMX-088381041C0700X
NMSWB-2022-0294104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18677037Medicaid