Provider Demographics
NPI:1295535292
Name:SANTIAGO, JANAE ELISE
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:ELISE
Last Name:SANTIAGO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15600 SW 136TH ST UNIT 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3099
Mailing Address - Country:US
Mailing Address - Phone:786-402-1310
Mailing Address - Fax:
Practice Address - Street 1:15600 SW 136TH ST UNIT 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3099
Practice Address - Country:US
Practice Address - Phone:786-402-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-404381106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician