Provider Demographics
NPI:1336542141
Name:SANTIAGO, MARITZA
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 1DE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2611
Mailing Address - Country:US
Mailing Address - Phone:347-577-5844
Mailing Address - Fax:
Practice Address - Street 1:2940 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1DE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2611
Practice Address - Country:US
Practice Address - Phone:347-577-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health