Provider Demographics
NPI:1396920948
Name:SANTIAGO, LIDIA (LMSW)
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841969
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5900 CHIMNEY ROCK RD
Practice Address - Street 2:SUITE Y
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2706
Practice Address - Country:US
Practice Address - Phone:713-661-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26075104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker