Provider Demographics
NPI:1245541390
Name:SANTIAGO, LINDA D (MA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HIRST AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2520
Mailing Address - Country:US
Mailing Address - Phone:610-626-1128
Mailing Address - Fax:
Practice Address - Street 1:3900 CITY AVE
Practice Address - Street 2:SUITE 1207
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2908
Practice Address - Country:US
Practice Address - Phone:215-878-3052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor