Provider Demographics
NPI:1881483105
Name:SANTIAGO HERNANDEZ, LETICIA (MSW)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:SANTIAGO HERNANDEZ
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13200 S SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-6192
Mailing Address - Country:US
Mailing Address - Phone:928-257-0992
Mailing Address - Fax:
Practice Address - Street 1:2180 S 4TH AVE STE C
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6479
Practice Address - Country:US
Practice Address - Phone:928-919-9521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker