Provider Demographics
NPI:1669692307
Name:SANTIAGO, JACQUELINE M (MSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CALLE ALMIRANTE PINZON
Mailing Address - Street 2:URB. EL VEDADO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3208
Mailing Address - Country:US
Mailing Address - Phone:939-644-7467
Mailing Address - Fax:
Practice Address - Street 1:116 CALLE ALMIRANTE PINZON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3208
Practice Address - Country:US
Practice Address - Phone:939-644-7467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR64441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical