Provider Demographics
NPI:1649876905
Name:DESANTIAGO, JUAN ALEXANDER (LCSW)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ALEXANDER
Last Name:DESANTIAGO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 LONGMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-6354
Mailing Address - Country:US
Mailing Address - Phone:940-445-2781
Mailing Address - Fax:
Practice Address - Street 1:2000 LONGMEADOW CT
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-6354
Practice Address - Country:US
Practice Address - Phone:469-443-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical