Provider Demographics
NPI:1780365924
Name:SANTIAGO, VERONICA MICHELLE
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:MICHELLE
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 1:5 LIONEL BENOIT RD APT A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-2946
Mailing Address - Country:US
Mailing Address - Phone:413-517-4736
Mailing Address - Fax:
Practice Address - Street 1:5 LIONEL BENOIT RD APT A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-2946
Practice Address - Country:US
Practice Address - Phone:413-517-4736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10140000101101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor