Provider Demographics
NPI:1205453057
Name:SANTIAGO, STEFANIE (LMFT, LCADC)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LMFT, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 VALLEY RD APT 2
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2209
Mailing Address - Country:US
Mailing Address - Phone:973-281-7164
Mailing Address - Fax:
Practice Address - Street 1:823 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-8401
Practice Address - Country:US
Practice Address - Phone:973-928-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00318100101YA0400X
NJ37FI00193500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)